Wednesday, July 04, 2007

Medicare Mental Health Copayment Equity Act of 2007

Here is the letter that the Medicare Mental Health Equity Coalition (MMHEC) sent to Senators John Kerry (D-Mass.) and Olympia Snowe (R-Maine), thanking them for re-introducing this bill, which would end the discriminatory policy of charging copays for outpatient mental health care which are 250% that of copays for non-mental health care. It takes six years to transition under the plan, but it is better than nothing. It is simply amazing that this type of discrimination has remained for as long as it has.
The undersigned organizations of the Medicare Mental Health Equity Coalition, representing patients, health professionals, health care systems and family members, applaud your introduction of the Medicare Mental Health Copayment Equity Act of 2007 (S.1715). Your legislation will eliminate the unfair provision in federal law imposing a 50 percent coinsurance rate for outpatient mental health services under Medicare instead of the usual 20 percent coinsurance for outpatient services. Our coalition supports enactment of legislation like this that will bring payments for mental health care in line with those required for all other Medicare Part B services.

The Medicare program was established to guarantee health care coverage for all older adults and people with disabilities. However, the 50 percent coinsurance for mental health services has proven to be a harmful barrier preventing many Medicare beneficiaries from accessing services they need. Since its enactment in 1965, we have learned that mental health disorders are highly prevalent in the elderly and disabled populations covered by the Medicare program. A landmark report by the Surgeon General on mental illness in 1999 found that 20 percent of the population aged 55 and older experience mental disorders that are not part of what should be considered as normal aging. In addition, a 2006 report by George Washington University found that 59 percent of Medicare beneficiaries with disabilities have a mental illness and 37 percent have a severe mental illness. Tragically, only about half of those experiencing a mental illness receive mental health treatment, due in large part to antiquated and discriminatory health coverage provisions, such as the 50 percent coinsurance rate under Medicare.

There is simply no reason for maintaining a discriminatory barrier to mental health care for America’s seniors and individuals with disabilities, particularly since these populations present a high incidence of mental health concerns.

We greatly appreciate your leadership in addressing this fundamentally unfair Medicare policy for the 44 million Americans that depend on this program.

MMHEC member organizations include the American Association of Geriatric Psychiatry, the American College of Physicians, the American Psychiatric Association, the American Psychological Association, the Association for Behavioral Health and Wellness, the Center for Medicare Advocacy, Inc., the Medicare Rights Center, Mental Health America, the National Alliance on Mental Illness, the National Association of Social Workers, the National Committee to Preserve Social Security and Medicare, the National Council for Community Behavioral Healthcare, Psychologists for Long Term Care, Inc., and the Suicide Prevention Action Network USA.

Please write each of your senators, asking them to co-sponsor this bipartisan bill to end this antiquated, discriminatory policy against people who require mental health treatment.


Anonymous said...

I could rant about medicare. Okay, I will.

Parity for co-payment is an important PRINCIPAL, but the issues with medicare are huge and parity for co-payments is not the logistically most important one.

1) For psychiatrists, medicare sets a limiting charge even for psychiatrists who don't participate. The maximum fee that can be charged is just under half my usual fee for an evaluation (2 hours, and I often will spend a fair amount of time on a note to the referring doc, more often doing that with medicare pts than with the younger crew). For a therapy session, there's about a significant decrease.
This means that psychiatrists often limit their medicare patientload because it's a losing deal (an internist friend tells me he has similar issues). This means that Medicare patients often have trouble finding a psychiatrist.

Okay, limiting the fees paid to docs, therefore limiting what the government and patient must pay may be a good thing. (Hmmm...if you're the government or a financially limited wannabe patient). I don't participate in medicare and my patients pay the fee upfront, then get reimbursed by medicare-- on a good day. With few exceptions, my medicare patients are all financially solvent people living comfortable lifestyles, often with a lot of travel, none of them are struggling the way some of my younger patients are.

It seems to me unreasonable that financially well-off folks are given a fee reduction independent of income when others who are often more financially strained, do not get this automatic fee-capping compliments of the government. It also seems unreasonable that it makes it so difficult for these folks to find care. If you say, I have the resources, I'm willing to pay for top notch care, the government says "Sorry you can't." No one else has this exclusion.

Having said that, I've never actually refused to see a patient because they have medicare, but that's because I don't have a large number of medicare patients in my private practice. In my clinic practice, I don't deal at all with the finances, they pay me by the hour (much less than in private practice), I see the patients and don't know what happens with the money.

Most of my clinic medicare crew have persistant and severe mental illnesses, they aren't traveling anywhere, and they also have Medicaid, so I don't think they're making any co-pays. And the Medicare-only patients are so overwhelmed by trying to get meds, that the co-pay issue is nothing in comparison. Yes, Medicare now has prescription coverage, but the poor can't afford it and there's something like a $2500/yr donut coverage leaving a lot of the cost of the meds to the patient which the poor simply can't afford.

I just don't hear people complain about the co-pay.

What I do hear people complain about is how hard it is to get reimbursed from medicare after they've paid up front. Rougly half my claims are denied. They don't tell me why other than not enough information. If I've made a mistake, say I've had the wrong medicare number-- it takes forever to sort this out-- you'd think they'd call, or at least say "number doesn't match name" but they don't. I resubmit and often that works. If I call and tolerate being on hold for 25 minutes, they won't tell me what's wrong anyway since I'm not a Medicare participant, the patient has to call. Somehow, they can refuse one appointment filed on the same form (has the exact same information) while paying on another appointment. And then there was the time they decided my name had to be stamped in box 32 as well as box 33 (same information adjacent to itself) and bounced claims for every practioner I knew who wasn't aware of this change (which was everyone I asked). It all feels pretty random and designed to frustrate the dr/patient out of requesting reimbursement. I would never participate in Medicare because I believe I would not get paid at all and the work of having to keep track of it would cost more than it's worth. If I had a high-volume, med-checky practice with a secretary, maybe it would work.

Rah parity.

I'll stay anonymous for this particular rant, thank you.

Sarebear said...

Agh. Now on the campaign trail, Kerry will tout this as he's taking care of people w/mental illness, legislative-wise . . . . but only those w/Medicare, and Anonymous ranter brings up a bunch of the problems with it.

That said, it's MUCH better than nothing; this 50% outpatient mental health co-pay has been a glaring problem forever.

For everyone, but this is at least a step in the right direction.

I SHOULD be on Medicare for disability, as the judge declared me severely disabled, but because I had no access to mental health professionals for a long period, due to the 50% copay I couldn't afford, I have no records (other than GP records of my depression, but they discounted everything he said, even though it WAS a record, because he's a GP) . . . they couldn't make a determination for the dates I needed to get Medicare.

So maybe someone out there who needs the help, who couldn't get it before, will get it now, if this gets passed, and once it transitions. It'll help SOME, anyway, and that's a good thing.

Roy said...

Good points, Sara. That is why our dear "Anon" never hears anyone complain about the 50% copay... the ones who can't afford it never get within earshot of docs like Anon to complain in the first case. Instead, they either do without or they go to their PCP, who has long learned never to use a depression diagnosis code but to instead use "diagnoses" like Insomnia, Fatigue, or Poor Appetite (otherwise, they get hit with the 50% thing, too).

And, costs and such aside, it IS the principLE of the thing... I mean, if Medicare charged people with blue eyes or people with Type 2 diabetes (but not Type 1) or people with dark skin different copays, we wouldn't stand for it regardless of the "problems" with ending the discrimination. And we wouldn't take 6 years to get rid of it.

Somehow, the stigma of mental illness permits the acceptance of this long equity-restoration process (and what about reparations?).

And, I don't buy the financial reasons for the delay... some of the costs are just cost-shifting from Medicaid to Medicare or from BCBS to Medicare, and for the rest... well, with Iraq running about $10M per hour in costs, a few days of that should cover the extra costs for immediately eliminating the discrimination.

That would be a real Independence Day for many Americans!

Anonymous said...

I completely agree with Roy on the issue of parity and the role of stigma. I also agree with Roy that there is some self-selection of who walks in my door.

So perhaps the issue isn't of parity but of the government rate-setting, irrespective of a patient's ability to pay or how many other insurance policies a patient has (Medicare is always primary, the fee gets set, but patients often have one and sometimes two other health insurers, and after all finish reimbursing their discounted fee, the copay may be close to nothing).

For the moment my thought is this. Time goes by and Medicare's allowed fees go down-- they are now lower than I ever remember them being. If there is parity, who makes up the difference? Instead of dropping allowed rates by 7 percent (? or was it 9 percent?) as they did last year, do physician reimbursements drop by even more? Do less psychiatrists take Medicare and does access become more of an issue? Who picks up the tab? End the Iraq war? Count me in.

Anonymous said...

I did look at your blog and tried to make a response to the medicare issues, but for some reason was not successful in making a posting....a little challenged when it comes to blogs (a new thing for this old dog). The usual is the inequity in the 50% copay for mental health care in comparison to the 20% for somatic care. Clinics often end up eating the 50% copay (can get blood out of a turnip). As a result many clinics have discontinued taking Medicare only patients - will accept them if they have MA as coinsurance. So discrimination abounds as does stigma.

Anonymous said...

Between the post itself and the comments this has been most informative. I believe that the difficulty here is caused by Murphy's Law. When that stops running our world, there will be equality and peace.

Anonymous said...

sarebear you are either really dumb or this is a bogus post. If Social Security doesn't have enough info from your doctors or you aren't seeing any doctors then they send you to one of there doctors.

They have doctors who only work for them(I know because I called him up to try to see him and he said he doesn't have a private practice).

Thats how I got my claim approved.

LoisJones said...

As far as Anon...'s statements, your true colors really shine through your belief system. Since you don't take people with chronic and persistent MI who are typically on Medicare and/or Medicaid, why do you even have an opinion about this issue. You are treating the worried well who can affor your exorbitant fees so why do you care about those of us who struggle on Medicare. I pay my therapist half of his fee, so when I see him twice a week I pay a little over $100.00 per week. This money comes out of my $900.00 that I have to live on. So from a patients perspective, parity would certainly help. The professionals who are only interested in money and work only with the more 'worthy pocketbook', client need not concern themselves with the plight of others.

I am one of those people that has struggled all of my life to get the help that I need, I think that the arbitrary 190 lifetime limit on freestanding psychiatric facilities needs to end now, OR the same limitations should apply to each illness, cancer, diabetes, heart failure; after a person has used 190 inpatient days in their lifetime they should be kicked out of the hospital, just like they do the mentally ill

Sit on that!