Common use of Institution for Mental Disease (IMD Clause in Contracts

Institution for Mental Disease (IMD. The Contractor will cover short term stays in an Institution for Mental Disease (IMD) for members age 21 to 64 with an average length of stay of 30 days and maximum length of stay of 60 days. For Indiana Health Coverage Programs (IHCP) members enrolled in Hoosier Care Connect, MCEs can authorize stays in an IMD for mental health, behavioral health and substance use disorder inpatient services under the State’s 1115 waiver. IHCP will follow the definition in accordance with 42 CFR 435.1010 for establishing eligible IMD providers. Identified IMD providers will be provided to the MCE. The Plan may not require or create incentives for the member to receive services in an IMD versus a setting covered under the State Plan. In accordance with 42 CFR 435.1010, an IMD “means a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services. Whether an institution is an institution for mental diseases is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not it is licensed as such. An institution for Individuals with Intellectual Disabilities is not an institution for mental diseases.” This may include a hospital providing psychiatric or substance use disorder inpatient care or a sub-acute facility providing psychiatric or substance use disorder crisis residential services. The Plan must submit data related to IMD stays as outlined in the MCE Reporting Manual. The proposed services and settings will be reimbursable and subject to the requirements contained in 42 CFR part 438.