The Effects of Medicaid Section 1115 Serious Mental Illness Waivers on Healthcare Utilization and Suicide-Related Behaviors

项目总结 在美国，随着具有临床意义的心理疾病的流行，精神健康危机日益严重。 痛苦与日俱增，而获得行为健康服务的机会明显恶化。已经有了一个 特别是危机服务和住院床位的短缺，给 急诊科，并可能与更高的无家可归率有关，监禁 患有严重精神疾病且健康和福祉较差的人。精神科住院病床短缺 可以在一定程度上与医疗补助政策捆绑在一起，该政策不允许联邦政府为住院的精神病人支付费用 疾病“(IMDS)，拥有超过16张床位的机构，专门从事行为健康治疗。 最近，医疗保险和医疗补助服务中心(CMS)为各州创造了一个申请机会 免除患有严重精神疾病(SMI)的成年人在IMD停留的联邦付款，以及 有严重情绪障碍(SED)的儿童。11个州已经收到了SMI/SED豁免，以及 其中五项尚未完成。这些豁免有可能改善危机护理和门诊精神卫生保健， 潜在地减少急诊室的使用和寄宿，改善护理的协调，以及 减少自杀和自杀相关行为。然而，目前尚不清楚这些豁免是否导致 服务中的更改或哪些状态实现在改进结果方面最成功。 这项全面的混合方法研究将通过以下方式评估消除IMD排斥的效果 SMI豁免。交错的豁免审批流程创建了一个自然的实验，以比较 对那些不这样做的人实施豁免。我们的定量分析将使用改造后的医疗补助 统计信息系统分析文件(TAF)，这是一个全国性的医疗补助数据集，包括以下信息 与服务利用和处方药使用相关的资格、登记和索赔。我们的定性分析将 探索可能导致结果变化的州一级因素。为回应PAR-21-316，我们的 建议的研究将确定影响访问、利用和成果的政策和因素，使用大型 Medicaid索赔数据集，并利用现有的数据管理方法来推进我们的研究。

PROJECT SUMMARY There is a growing mental health crisis in the US, with the prevalence of clinically significant psychological distress growing while access to behavioral health services apparently worsening. There has been a particular shortage in the availability of crisis services and inpatient beds, placing a greater burden on emergency departments and potentially associated with higher rates of homelessness, incarceration of persons with serious mental illness, and worse health and wellbeing. The shortage of inpatient psychiatric beds can be tied in part to Medicaid policies that do not allow federal payment for stays in “Institutions for Mental Diseases” (IMDs), facilities with more than 16 beds that specialize in behavioral health treatment. Recently, the Centers for Medicare & Medicaid Services (CMS) created an opportunity for states to apply for waivers to receive federal payments for stays in IMDs for adults with serious mental illness (SMI) and children with serious emotional disturbances (SED). Eleven states have received an SMI/SED waiver, and five are pending. The waivers have the potential to improve crisis care and outpatient mental health care, potentially reducing emergency department use and boarding, improving the coordination of care, and reducing suicide and suicide-related behaviors. However, it is not yet clear whether the waivers have led to changes in services or what state implementations are most successful in improving outcomes. This comprehensive mixed-methods study will assess the effects of removing the IMD exclusion through the SMI waivers. The staggered waiver approval process creates a natural experiment to compare states that implement the waiver to those that do not. Our quantitative analysis will use the Transformed Medicaid Statistical Information System Analytic Files (TAF), a national Medicaid data set that includes information on eligibility, enrollment, and claims related to service utilization and prescription use. Our qualitative analysis will explore state-level factors that may contribute to changes in outcomes. In response to PAR-21-316, our proposed study will identify policies and factors that affect access, utilization, and outcomes, using large Medicaid claims datasets and leveraging an existing data management approach to advance our research.