Saturday, July 14, 2007

H.R.1663 - Stark's Medicare Mental Health Modernization Act

There are several bills before Congress that would help to end insurance discrimination against people with mental health problems. In addition to HR1663, there is also SB558, HR1367, and HR1424.

Here is Pete Stark's speech introducing his HR1663 [pdf], the Medicare Mental Health Modernization Act (my emphasis added):

Mr. STARK. Madam Speaker, I rise today with my colleagues JIM RAMSTAD of Minnesota and PATRICK KENNEDY from Rhode Island to introduce the Medicare Mental Health Modernization Act, a bill to provide mental health parity in Medicare. I have introduced a version of this bill in every Congress since 1994. Perhaps this time we can actually enact it.

Medicare's mental health benefit is fashioned on treatments provided in 1965, but mental health care has changed dramatically over the last 42 years. Medicare limits inpatient coverage at psychiatric hospitals to 190 days over an individual's lifetime. In addition, beneficiaries are charged a discriminatory 50 percent coinsurance for outpatient psychotherapy services, compared to 20 percent for physical health services.

The Medicare Mental Health Modernization Act eliminates this blatant mental health discrimination under Medicare and modernizes the Medicare mental health benefit to meet today's standards of care.

This bill is long overdue. One in five members of our senior population displays mental difficulties that are not part of the normal aging process. In primary care settings, more than a third of senior citizens demonstrate symptoms of depression and impaired social functioning. Yet only one out of every three mentally ill seniors receives the mental health services he/she needs. Older adults also have one of the highest rates of suicide of any segment of our population. In addition, mental illness is the single largest diagnostic category for Medicare beneficiaries who qualify as disabled.

There is a critical need for effective and accessible mental health care for our Medicare population. Recent research has found a direct relationship between treating depression in older adults and improved physical functioning associated with independent living. Unfortunately, the current structure of Medicare mental health benefits is inadequate and presents multiple barriers to access of essential treatment. This bill addresses these problems.

The Medicare Mental Health Modernization Act is a straightforward bill that improves Medicare's mental health benefits as follows:

It reduces the discriminatory co-payment for outpatient mental health services from 50 percent to the 20 percent level charged for most other Part B medical services.

It eliminates the arbitrary 190-day lifetime cap on inpatient services in psychiatric hospitals.

It improves beneficiary access to mental health services by including within Medicare a number of community-based residential and intensive outpatient mental health services that characterize today's state-of-the-art clinical practices.

It further improves access to needed mental health services by addressing the shortage of qualified mental health professionals serving older and disabled Americans in rural and other medically underserved areas by allowing state licensed marriage and family therapists and mental health counselors to provide Medicare-covered services.

Similarly, it corrects a legislative oversight that will facilitate the provision of mental health services by clinical social workers within skilled nursing facilities.

It requires the Secretary of Health and Human Services to conduct a study to examine whether the Medicare criteria to cover therapeutic services to beneficiaries with Alzheimer's and related cognitive disorders discriminates by being too restrictive.

In April 2002, President Bush identified unfair treatment limitations placed on mental health benefits as a major barrier to mental health care and urged Congress to enact legislation that would provide full parity in the health insurance coverage of mental and physical illnesses. We've made important strides forward for the under-65 population. Twenty-six states have enacted full mental health parity. The Federal Employees Health Benefits Plan (FEHBP) was improved in 2001 to assure that all federal employees and members of Congress are provided parity for mental health and substance abuse treatment. This month, Representatives KENNEDY and RAMSTAD introduced H.R. 1424 , the Paul Wellstone Mental Health and Addiction Equity Act, to provide full parity for mental health and substance abuse in the private insurance market nationwide.

I'm proud to join them in support of this legislation, which was introduced with 256 cosponsors--well more than the 218 majority needed to pass the House of Representatives.

While some in the business community are concerned about increased costs associated with providing these benefits, a recent study of the FEHBP mental health coverage concluded that implementation of parity benefits led to negligible cost increases. In fact, some businesses are now embracing parity because they recognize the increased productivity from workers over the long run and how improving access to mental health services has the potential to avoid other additional costly care.

I am similarly sure that modernizing the Medicare mental health benefit will reduce unnecessary spending. Medicare mental health expenses have historically been heavily skewed toward more expensive inpatient services, with 56 percent of the total going to inpatient care and only 30 percent toward outpatient services in 2001. This relationship is in contrast to national trends showing a reversal in inpatient and outpatient spending over the past decade. In the last 10 years, inpatient spending declined from 40 percent to 24 percent, while outpatient spending increased from 36 percent to 50 percent of all mental health spending. In addition, improving beneficiary access to timely mental health care could well yield savings by minimizing the need for other services.

Science has demonstrated that mental illness and substance abuse are manifestations of biological diseases. It is long past time for
us to take action with regard to Medicare's inadequate mental health benefits and structure. Over the years, Congress has updated Medicare's benefits for treatment of physical illnesses as the practice of medicine has changed. The mental health field has undergone many advances over the past several decades. Effective research-validated interventions have been developed for many mental conditions that affect stricken beneficiaries. Most mental conditions no longer require long-term hospitalizations, and can be effectively treated in less restrictive community settings. This bill recognizes these advances in clinical treatment practices and adjusts Medicare's mental health coverage to account for them.

The Medicare Mental Health Modernization Act removes discriminatory features from the Medicare mental health benefits while facilitating access to up-to-date and affordable mental health services for our senior citizens and people with disabilities. I urge my colleagues to join Mr. RAMSTAD, Mr. KENNEDY, and myself in support of this important legislation and to work with us to improve mental health coverage for everyone.


Anonymous said...

We know it's the weekend when Roy appears!

Hi, Roy.

No picture? Can we stick up a photo of Pete Stark or something?

Seriously, a few confusing issues-- You posted on HOUSE bill to end discrimination agains mental illness, but there is also a SENATE bill which offers less, is supported by the insurance industry, and when we go to talk about Federal Parity Bills, it all gets rather confusing.

And then there's the issue of the states-- Maryland already has some of the best provisions against Mental Health Discrimination and there are those who are worry that a Federal Bill would offer less and supercede the state laws, thus eroding progress that's already been made.

The APA supports both bills. The New York Psychiatric Society (or whatever the official organization name is) is opposed for fears that national gains will be their state's loss.

One big concern here in Maryland is that current laws do not include those those who have Health Insurance under ERISA and that Federal legislation would include them. So perhaps have current laws eroded is offset by having protections in place for more people (or as the insurance companies call us "Lives.")

It's a complicated issue.

Oh, The New York Times had a nice article discussing the House versus the Senate bill back in March, 2007:


Roy said...

I've got a few other posts in draft that I am working on, which each highlight the other bills, and then a summary post with which I hope to compare and contrast.

It comes down to this: Do you hold out on principle and support only the House bill (H.R.1424), taking the chance that both fail and the chance to get a parity bill doesn't come up for another eleven years?

Or, do you support the Senate bill (S.558), which may partially preempt states with better parity laws, while expanding parity language to ERISA-based plans, which are not covered by state laws?

Is half-a-loaf better than none?

Gerbil said...

This is a confusing issue!

I guess the question boils down to a cost-benefit analysis that not only pits the two bills against each other, but also the individual (i.e., the state) against the group (i.e., the nation).

That is: if the Senate bill passes, is the aggregate benefit to all states greater than the harm to the individual states with existing parity legislation?

And to throw yet another wrench into the works: let's imagine that there is a federal parity law which allows states to enact their own, more inclusive laws. If a particular disorder is considered SMI in State A but not in State B (or in the hypothetical federal statute), can someone who previously enjoyed SMI benefits in State A sue State B--or the federal government--for discrimination?

My head spins.

Anonymous said...

Hey, Shrinks,
I have a question unrealted to the present topic. Have any studies been done on the very long term effects of antidepressants? I have been taking them for so long my first one was Desipramine. Does your brain finally get pickled? Am I the same person I would have been without them? By the way, I am grateful every day for them, and for the shrinks who prescribed them. Thanks.

Anonymous said...

There is nothing confusing about these issues! As a disabled person who relies on Medicare for my mental health coverage (which is also my disability), I have written letters to senators etc. made phone calls and even tried to get the ACLU to pick up this issue on my behalf. Those of us who suffer from chronic/persistent mental illnesses due to early trauma actually want help. But I have already used all but 7 days of my 190 lifetime limit. I am 50 years old, so if I need hospitalization I will have to go to substandard institutions that do not have PROGRAMS to help people with my diagnosis. The ACLU is only interested in helping people with a mental illness who have landed in prison.

When will this arbitrary 190 day lifetime limit end? Why can't this country show a little compassion for those of us who suffer under a system that discriminates against us?

It's time for this BS to end, it probably won't happen in my lifetime, afterall it seems more important that we spend billions on Bushs war, God forbid that we allow someone like me to seek inpatient hospitalization.

This is my life and tens of thousands just like me that we are talking about.

God, when will someone help us?