APA, Mental Health Advocates Discuss Need For Medicare Parity

Main Category: Mental Health
Also Included In: Medicare / Medicaid / SCHIP;  Psychology / Psychiatry
Article Date: 22 Apr 2008 - 3:00 PST

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The disparity of the 50 percent Medicare coinsurance requirement for mental health services reflects an outmoded benefit design on obsolete understandings of the nature of mental disorders and our ability to successfully treat people with these serious illnesses, said American Psychiatric Association President Carolyn Robinowitz, M.D., during a Senate briefing held today by the APA and the Mental Health Medicare Equity Coalition.

The APA currently chairs the national coalition, comprised of 15 national healthcare organizations representing patients, health professionals, health care systems and family members. The coalition advocates for parity coverage of mental health services in Medicare Part B.

Medicare Part B, the component of Medicare that covers outpatient care, does not provide parity coverage. While Part B covers 80 percent of the cost of most services, only 50 percent of the cost of most mental health care services is covered.

Legislation (S. 1715) sponsored by Senators Olympia Snowe (R-Maine) and John Kerry (D-Mass.) would phase the discriminatory 50 percent coinsurance for outpatient mental health services down to 20 percent over the next six years. A companion bill (Seniors Access to Mental Health Act of 2007, H.R. 1571) has been introduced in the House. The Children's Health and Medicare Protection (CHAMP) Act bill (H.R. 3162), which passed the House in August 2007, contains a provision that would immediately adjust the coinsurance for mental health outpatient services to the usual rate that applies to other outpatient services.

The 50 percent coinsurance policy, according to the Coalition, creates obstacles to care and increases costs. "Medicare beneficiaries have an elevated need for mental health services, and data points to the coinsurance requirement as a serious barrier to appropriate services," Robinowitz said during the briefing. "Of those beneficiaries who use mental health services, use of outpatient services is comparatively low, while use of costly inpatient services is high. These data paint a dismal picture of the coinsurance policy: high-needs patients are kept from care and costs escalate."

The high coinsurance is a major barrier to needed services. According to Robert Roca, M.D., M.P.H., Vice President and Medical Director, Sheppard Pratt Health System, "Medicare was established to serve two vulnerable populations - the elderly and people with disabilities - groups that have high mental health needs. Ironically, the 50 percent coinsurance represents an unusually high barrier for people who have a particular need for mental health services," he said.

According to Roca, access barriers have resulted in large numbers of people not receiving the care they need. "Looking at older adults generally, the epidemiological evidence tells us that they are as likely as other adults to experience mental illnesses," he said. "Unfortunately, the implications of access barriers and the subsequent untreated mental illness are serious and have resulted in large numbers of people not receiving the care they need."

In fact when you look at a recent analysis of the Medicare program, the data demonstrates a prevalence of mental disorders that is higher than that of the general population. The 2006 review of prevalence data by researchers at the George Washington University found:

- 26 percent of Medicare beneficiaries have mental disorders, compared to 21 percent of the general population.
- 59 percent of Medicare beneficiaries with disabilities have a mental disorder, and 37 percent of them have severe disorders.

In 2002, the federal Center for Mental Health Services reported on this treatment gap in Medicare. It found that 85.5 percent of Medicare beneficiaries 65 and over who needed mental health treatment did not receive it. For beneficiaries under 65, 64 percent were unable to receive needed services due in part to limited outpatient treatment and high cost-sharing requirements.

Other featured speakers at the briefing included Ron Manderscheid, Ph.D., Director of Mental Health and Substance Use Programs, Constella Group; and, David Shern, Ph.D., President and CEO, Mental Health America.

About the American Psychiatric Association

The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at http://www.psych.org and http://www.HealthyMinds.org.