Last Thursday, after about a year of discussion and focus groups, several agencies in the Executive Office of Health and Human Services released their updated policy to help move psychiatric patients waiting in emergency departments – which is known as “boarding” – to inpatient admission. Boarding occurs for a variety of reasons, including lack of appropriate beds, the inability to locate a psychiatric bed in a unit close to the patient, and communication and authorization breakdowns between providers, insurers, and state government.
The new Expedited Psychiatric Inpatient Admissions Policy, or EPIA 2.0, builds on the original EPIA that was released in February 2018. A major change is that the “escalation process” – that is, the clear steps and responsibilities that trigger involvement by senior clinical leadership at acute care hospitals, health insurance companies, and inpatient psychiatric units and facilities– will now begin after 24 hours of a patient not being admitted, rather than 48 hours. A point person for each shift must be identified and all stakeholders will have to use a standard bed search protocol, which is still in development. On the payment side, additional reimbursement that may be necessary to ensure admission to an inpatient unit/facility – known as “specialing” for single rooms, additional staff, etc. – must be offered by the health plan, and that authorization must be documented.
Further changes to payer and provider responsibilities are also outlined in the new EPIA 2.0, which goes into effect immediately.