Institutions for Mental Diseases (IMD) 510-05-35-97

(Revised 1/1/18 ML #3508)

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IM 5402

 

An individual under age 65 who is a “patient” in an IMD is not eligible for Medicaid, except as identified in subdivision d, unless the individual is under age 21 and is receiving inpatient psychiatric services and meets the certificate of need for admission. An individual who attains age 21 while receiving treatment, and who continues to receive treatment as an inpatient, may continue to be eligible through the month the individual attains the age of 22.

1. An IMD is 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. A facility with 16 beds or less is not an IMD. Whether an institution is an IMD is determined by its overall character as that of a facility established and maintained primarily for the care and treatment of mental diseases. An intermediate care facility for individuals with intellectual disabilities (ICF-ID) is not an IMD.
   
   IMDs include the North Dakota State Hospital, Prairie at St. John's, and the Red River Behavioral Health System. Psychiatric Residential Treatment Facilities with more than 16 beds are considered IMDs. For any other facility, contact the Medical Services Division for a determination of whether the facility is an IMD.
   
   
2. An individual on conditional release or convalescent leave from an IMD is not considered to be a “patient” in that institution. However, such an individual who is under age 21 and has been receiving inpatient psychiatric services is considered to be a “patient” in the institution until unconditionally released or, if earlier, the last day of the month in which the individual reaches age 22.
   
   
3. An individual on conditional release is an individual who is away from the institution, for trial placement in another setting or for other approved leave, but who is not discharged. An individual on "definite leave" from the state hospital is an individual on conditional release.
   
   
4. A child under the age of 21 who is determined to be continuously eligible for Medicaid, but who does not meet the certificate of need, remains eligible for Medicaid, however, no medical services will be covered during the stay in the IMD.

The period of ineligibility under this section begins the day after the day of entry and ends the day before the day of discharge of the individual from an IMD. A Ten-Day Advance Notice is not needed when terminating benefits due to entry into the IMD. See Paragraph (4)(c)(iii) of 510-03-25-25, "Decision and Notice," for further information.