MEPD IRB Section 9 Rationale

Request for Review of Claim of Exemption
Section 9: Rationale for Exempt Category Claimed
Mathematica Policy Research
Medicaid Emergency Psychiatric (Services) Demonstration (MEPD)
Medicaid statutes prohibit the Centers for Medicare and Medicaid Services (CMS) from
providing federal matching funds for inpatient services that institutions for mental
disease (IMDs) provide to adults. The MEPD waives this statute in 27 private IMDs in
11 states and the District of Columbia for care provided to Medicaid beneficiaries age
21 to 64 who are suicidal, homicidal, or dangerous to themselves or others. This
project’s objective is to complete a congressionally-mandated evaluation of MEPD and
examine the demonstration’s effects on access to inpatient and emergency department
(ED) care, discharge planning, and cost to Medicaid, states, and IMDs. We will collect
information from and on staff involved in, and beneficiaries served by, the
demonstration through interviews, medical record reviews, and secondary data
analyses of Medicaid and Medicare claims obtained from CMS and participating states
and hospitals. Project directors of the state demonstrations will assist in identifying staff
involved in the demonstration for interviews. Hospital staff will recruit and obtain consent
from 135 beneficiaries and, if relevant, their guardians. We will conduct telephone
interviews with beneficiaries after their condition has stabilized and they have been
discharged from the hospital. There is minimal risk from staff and beneficiary
involvement. We will ask staff about routine hospital policies and procedures. We will
ask beneficiaries about their experiences with, and quality of, care received in the
hospital and ED. The questions are similar to those in a routine psychological
examination. We will securely store all data. We will remove personal identifiers and
securely destroy sensitive data at the earliest opportunity. Access to data will be on a
need-to-know basis. Claims data will be encrypted in transit and at rest. Information will
not be attributed to individuals in reports. All data will be destroyed at the end of the
project.