American Hospital Association Lobbies Congress to Address ‘Discriminatory’ and ‘Outdated’ Behavioral Health Regulations

The American Hospital Association (AHA) is lobbying Congress to address several systemic behavioral health issues. 

AHA requests that the House Committee on Energy and Commerce consider several actions in addition to renewing the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (SUPPORT Act). 

In a letter sent to key members of the House committee, the organization requested that lawmakers address psychiatric and behavioral health care payment, administrative burdens, regulatory red tape and workforce development. 


“Arbitrary and outdated payment policies continue to reflect the undervaluing of behavioral health services,” Lisa Kidder Hrobsky, senior vice president of advocacy and political affairs, wrote in the letter. “Addressing these gaps in payments for behavioral health providers must be a key element of any legislative package seeking to expand access to behavioral health care.”

Several of the letter’s requests have been advocacy priorities for years.

AHA is proposing ending the Medicaid institutions for mental disease (IMD) exclusion and halting the lifetime limit on Medicare psychiatric facility care. The group is also calling on lawmakers to clarify the Emergency Medical Treatment and Labor Act (EMTALA). 


While the letter doesn’t address reimbursement parity, it presents several regulatory challenges unique to the behavioral health space. For example, it points out that “no other Medicare specialty inpatient hospital service has this type of arbitrary cap on benefits,” when referring to the 190-day limit on care for Medicare beneficiaries. 

The letter also highlights the need to revisit out-of-date or irrelevant regulations.

The Social Security Amendments of 1965, which created Medicare and Medicaid, included the IMD exclusion. This exclusion withholds federal Medicaid payments for inpatient behavioral health treatment for beneficiaries aged 21 to 64 at facilities with more than 16 beds. 

“The discriminatory IMD policy was established at a time when [substance use disorders] were not considered medical conditions on the same level as physical health conditions,” the letter noted. “The exclusion is one of the few examples of Medicaid law prohibiting the use of federal financial participation for medically necessary care furnished by licensed medical professionals to enrollees based solely on the health care setting providing the services.”

The SUPPORT Act created a provision for state Medicaid programs to grant exemptions from the IMD exclusion. The letter says such exemptions prevented long-term institutionalization, one objective of the exclusion.

The letter also explained that enforcement of EMTALA, which largely mandates emergency departments stabilize all patients, has gone beyond the law’s original intent. It contends that over-interpreting leads to additional compliance burdens. 

It also encourages the House Commerce and Energy Committee to advance legislation that would compel the Drug Enforcement Administration (DEA) to establish a “special registration” procedure to exempt telehealth services from needing in-person exams before prescribing certain medications. 

Congress passed such legislation in 2008 as part of the Ryan Haight Act and again in the SUPPORT Act.

“To date, the DEA has continued to ignore congressional intent on this process, and it is clear more congressional action is needed in the reauthorization of the SUPPORT Act,” the letter stated. 

The DEA has gone beyond ignoring congressional mandates to ease access to telehealth. It has delayed the implementation of a proposed rule that would clawback most of the telehealth flexibilities established during the federal COVID-19 public health emergency.

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