Repealing the IMD Exclusion Act
Summary
What This Bill Does
This bill removes the Medicaid medical assistance exclusion for patients in institutions for mental diseases and rewrites the Social Security Act definition of IMD. An IMD would be a hospital, nursing facility, or other institution primarily engaged in diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services, and it would have to meet nationally recognized, evidence-based standards for mental health programs and, when applicable, substance use disorder programs approved by the Secretary. The changes take effect 180 days after enactment for State plans.
Who Benefits and How
Medicaid beneficiaries needing inpatient mental health or substance use disorder treatment benefit from broader potential Medicaid coverage for IMD services. IMD hospitals and nursing facilities that meet evidence-based standards may gain access to Medicaid payment streams that were restricted by the prior age exclusion.
Who Bears the Burden and How
State Medicaid agencies, the Secretary of Health and Human Services, and institutions for mental diseases must administer the new coverage and standard-setting regime. IMDs that want Medicaid payment must comply with nationally recognized, evidence-based mental health and substance use disorder program standards, while States may face higher Medicaid spending and plan-administration work as coverage expands.
Key Provisions
- Repeals the Medicaid age-based exclusion for medical assistance in institutions for mental diseases.
- Redefines IMDs as facilities primarily engaged in mental disease diagnosis, treatment, or care.
- Requires IMDs to meet nationally recognized, evidence-based mental health program standards approved by the Secretary.
- Requires substance use disorder standards for IMDs that provide substance use disorder treatment.
- Applies the amendments to State Medicaid plans 180 days after enactment.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Repeal the Medicaid institution-for-mental-diseases age exclusion and require IMDs to meet nationally recognized, evidence-based mental health and substance use disorder standards.
Key Policy Areas
Medicaid, Mental Health, Healthcare
Primary Purpose
Repeal the Medicaid institution-for-mental-diseases age exclusion and require IMDs to meet nationally recognized, evidence-based mental health and substance use disorder standards.
Policy Domains
Substantive provisions
Identified Gains
- Medicaid beneficiaries needing inpatient mental health care
- Substance use disorder patients
- Institutions for mental diseases meeting standards
Identified Costs
- State Medicaid agencies
- Secretary of Health and Human Services
- Institutions for mental diseases
- State Medicaid budgets
Legislative Progress
In CommitteeMr. Torres of New York introduced the following bill; which …
Referred to the House Committee on Energy and Commerce.
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Institutions for mental diseases meeting evidence-based standards, Medicaid beneficiaries needing inpatient mental health care, Substance use disorder patients
Positive-direction: Medicaid beneficiaries needing inpatient mental health care, Substance use disorder patients
Negative-direction: Institutions for mental diseases meeting evidence-based standards
State Medicaid agencies administering IMD coverage
Department of Health and Human Services standard-setting staff
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "Cost bearers"
- → ['State Medicaid budgets']
- "Beneficiaries"
- → ['Medicaid beneficiaries', 'Patients', 'Institutions for mental diseases']
- "Administrators"
- → ['State Medicaid agencies', 'Secretary of Health and Human Services']
Key Definitions
Terms defined in this bill
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology