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IMD Legislation Introduced in Congress

Updated: Jun 2, 2021

Representative Grace Napolitano (D-CA-32) introduced a bill recently entitled “Increasing Behavioral Health Treatment Act” (H.R. 2611) This legislation proposes to get rid of the IMD exclusionary rule entirely which would be extremely beneficial to our members operating residential treatment facilities.

The Family First Prevention Services Act of 2018 (FFPSA) places new requirements on providers across the country to become QRTPs, meaning they must be licensed, accredited, and have registered or licensed nursing staff and licensed clinical staff onsite according to the treatment model and available 24/7.

Based on the Centers for Medicare and Medicaid Services (CMS) current definition and how a QRTP is defined in FFPSA, CMS may consider QRTPs over 16 beds to be Institutions for Mental Diseases (IMDs). Thousands of children in the foster care system may not be able to access Medicaid funds for their medical, dental, behavioral, and mental health care needs while they are placed in a QRTP with more than 16 beds because of the IMD exclusion. This is a serious unintended consequence of the FFPSA.

This legislation seeks to fix this unintended consequence and ensure that Medicaid coverage for children in QRTPs will not be put in jeopardy. FFPSA must be implemented by all states on October 1, 2021.


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