APA Fights New Standards For Inpatient Services
A new Medicare local coverage determination (LCD) for “inpatient psychiatric hospitalization” has been issued that may set a dangerous precedent.
In February the fiscal intermediaries who administer Medicare Part A in the Midwest (AdminaStar) and New England (Associated Hospital Service) issued the first LCD for psychiatry services. “As written,” says Ellen Jaffe, Medicare specialist in the Office of Healthcare Systems and Financing, “the LCD creates standards for certification and documentation for inpatient psychiatric care that are so onerous that many in the field believe no inpatient facility will be able to comply with them.”
She explained that the standards being put forth go beyond any that are currently required by private insurers. “They seem to have been written without reference to how inpatient psychiatric treatment is actually provided.”
Why the Concern?
There is concern that facilities will not be willing to take the risk of being out of compliance with standards put forth by government contractors and will withdraw from the Medicare program, leaving Medicare beneficiaries without access to necessary inpatient psychiatric care.
Because standards promulgated by the Medicare program have been adopted by private insurers in the past, there is also concern that if this LCD remains in place, the unrealistic standards it sets may eventually be required for all inpatient psychiatric care—whether furnished under Medicare or a private insurance plan.
Procedures Were Not Followed
Federal regulations establish a clear process for the development of LCDs that includes the active involvement of all those who will be affected by the determinations. In this case, psychiatrists and psychiatric facilities and those who participate in inpatient psychiatric care, including representatives from the patient community, would be affected.
Despite this requirement, this LCD was finalized without receiving input from the specialty community that would be affected by it. Although the fiscal intermediaries held public meetings as required by Medicare, apparently no notices were disseminated about the meetings.
APA Seeks LCD Withdrawal
For these reasons, APA is contending that the current LCD for “Inpatient Psychiatric Hospitalization” is invalid and should be withdrawn.
APA is working with the National Association of Psychiatric Health Systems (NAPHS), the National Association of State Mental Health Program Directors, the Massachusetts Hospital Association (MHA), the Massachusetts Association of Behavioral Health Systems (MABHS), and the American Hospital Association (AHA) to have the LCD withdrawn.
Action Taken to Date
APA and the NAPHS sent a letter to the fiscal intermediaries in January setting out the illegality of the process that was used to develop the LCD. In March Irvin (Sam) Muszynski, J.D., director of APA’s Office of Healthcare Systems and Financing, attended a meeting at the Centers for Medicare and Medicaid Services (CMS) regional office in Boston with the medical directors of AdminaStar and Associated Hospital Services (Richard Baer, M.D., and Gary Weaver, M.D., respectively); representatives from CMS, MABHS, and MHA; and providers of inpatient psychiatric care in New England. Neither Baer nor Weaver was able to provide information that overturned the conclusion that proper procedures had not been followed for the development of the LCD.
Following the meeting, a letter was sent to Charlotte Yeh, M.D., regional administrator of the CMS office in Boston, requesting that the LCD be withdrawn immediately.
If the LCD is withdrawn, the Office of Healthcare Systems and Financing will work with the other stakeholders to craft a new LCD that more appropriately reflects how inpatient psychiatric care is delivered.
For questions about Medicare, call Ellen Jaffe, APA Medicare specialist, at (703) 907-8591. ▪
