Medicare Parity in Sight

Sen. Jon Corzine (D-N.J.) and Rep. Pete Stark (D-Calif.) introduced the Medicare Mental Health Modernization Act of 2003 (S 646/HR 1340) in March. The legislation would

• Eliminate the 190-day lifetime cap on inpatient services in psychiatric hospitals.

• Reduce Medicare’s discriminatory copayment for outpatient mental health services from 50 percent to 20 percent.

• Allow Medicare beneficiaries to receive intensive residential services for 120 days a year in the following settings: crisis residential treatment programs or mental illness residential treatment facilities, therapeutic family or group treatment homes, residential detoxification centers, and residential centers for substance abuse treatment.

• Allow Medicare beneficiaries to receive intensive outpatient services, including psychiatric rehabilitation, assertive community treatment, intensive case management, day treatment for individuals, and ambulatory detoxification.

• Allow clinical social workers who are providing diagnosis and therapy services to residents in skilled nursing facilities (SNF) to bill Medicare directly, as psychiatrists and clinical psychologists do.

• Provide a distinction between clinical social worker services and social services, clearing up any confusion between social services provided “in house” at the SNF and services provided by clinical social workers.

• Provide direct reimbursement to mental health counselors and marriage and family therapists for services they provide to Medicare beneficiaries, provided they are legally authorized to perform the services under state law.

• Require the secretary of Health and Human Services to conduct a study to determine whether the criteria for coverage of therapy services restricts access for Medicare beneficiaries who are diagnosed with Alzheimer’s disease or a related mental illness.

Nicholas Meyers, deputy director for government relations at APA, said, “We support many of the objectives of this bill, including the repeal of Medicare’s discriminatory 50 percent copayment, the elimination of the 190-day lifetime cap on inpatient services in freestanding psychiatric hospitals, and the establishment of intermediate-level residential and community-based treatment options.

“At the direction of Congress, however, MedPAC considered and emphatically rejected direct reimbursement to marriage and family therapists and mental health counselors, noting that such coverage ‘would likely increase costs. . .without improving access proportionately in problem areas. . .’ and that this ‘would not represent the best use of finite resources. . . . ’

“In this tight budget environment, it’s going to be a tremendous struggle to improve any Medicare mental health benefit. Congress should first correct long-standing structural inequalities, starting with the discriminatory 50 percent copayment.”