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

医疗补助第 1115 条严重精神疾病豁免对医疗保健利用和自杀相关行为的影响

基本信息

批准号：
10775350
负责人：
Kenneth John McConnell
金额：
$ 76.99万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-20 至 2027-07-31
项目状态：
未结题

项目摘要

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.

项目摘要在美国，心理健康危机日益增长，临床上重要的心理危机在获得行为卫生服务的同时，苦难显然会后悔。有一个危机服务和住院床的可用性特别短缺，更大的烧伤 emergencie departments and potentially associated with higher rates of homelessness, incidental of 患有严重精神疾病，健康和福祉的人。住院精神病床短缺可以部分与医疗补助政策有关，这些政策不允许在“精神机构的机构”中付款疾病”（IMDS），具有16张床的设施，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）为各州创造了机会 wavers收到有关患有严重精神疾病（SMI）和患有严重情绪障碍的孩子（SED）。 11个州已经收到了一个SMI/SED WAISTER，并且五个正在等待。脚有可能改善危机护理和门诊精神卫生保健，有可能减少急诊科使用和登机，改善护理的协调，并减少自杀和自杀相关行为。但是，目前尚不清楚甲板是否导致服务的变化或哪些州实施最成功地改善结果。这项全面的混合方法研究将评估通过 SMI豁免。交错的豁免批准过程创建了一个自然的实验，以比较将豁免实施给那些没有的豁免。我们的定量分析将使用变换的医疗补助统计信息系统分析文件（TAF），这是一个包括有关信息的国家医疗补助数据集资格，注册以及与服务利用和处方使用有关的索赔。我们的定性分析将探索可能导致结果变化的状态级别因素。为了回应PAR-21-316，我们的拟议的研究将使用大型研究确定影响获取，利用和结果的政策和因素 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。