APA Hails House Action To End Medicare Discrimination, USA

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Mental Health;  Psychology / Psychiatry
Article Date: 05 Aug 2007 - 1:00 PDT

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The American Psychiatric Association (APA) hailed passage of legislation that, among other provisions, includes language to end Medicare's 40 years of discrimination against patients requiring outpatient psychiatric services. The historic action came as the House passed the Children's Health and Medicare Protection (CHAMP) Act of 2007, H.R. 3162, a sweeping healthcare bill aimed at expanding the federal State Children's Health Insurance Program (SCHIP) and making numerous changes in the Medicare program.

Since the Medicare program was established some 40 years ago, enrollees using outpatient psychiatric services have by law had to pay an effective coinsurance of 50 percent - two and a half times the customary 20 percent coinsurance paid for other Medicare Part B services.

"For more than two decades, the APA has led the fight to end the undue burden against patients needing psychiatric care," said APA President Carolyn B. Robinowitz, M.D. "The APA commends the House - and particularly the House Health Subcommittee Chairman Pete Stark and Representative Tim Murphy, who led the effort - for taking this significant, pro-patient action."

Murphy (R-Pa..) is the author of APA-backed legislation to phase out the 50 percent coinsurance; Stark (D-Calif.) acted to ensure the 50 percent coinsurance would drop to 20 percent effective in 2008.

"There is no justification for making seniors and disabled Medicare enrollees pay so much more for mental health care, and yet sometimes it felt as if we were trying to move a mountain," said Dr.

Robinowitz. "There will be tough negotiations with the Senate about the whole package, and the APA will fight to make a 20 percent coinsurance for Medicare mental health services the law of the land. Today's patient-focused action is encouraging and we hope to move forward in this positive direction."

The legislation also includes language to:

-- Provide for Medicare Part D coverage of benzodiazepines, which are generic drugs used to treat anxiety and other psychiatric illnesses;

-- Codify the "All or Substantially All" policy (currently a regulatory guideline to ensure that Part D drug plans cover all or substantially all of the medications within certain classes: antipsychotics, antidepressants, anticonvulsants and antivirals, for example);

-- Prevent cuts to physician fees under Medicare for the next two years;

-- Raise the tobacco tax; and

-- Reduce excess payments to insurance companies.

About the American Psychiatric Association

The American Psychiatric Association is the nation's leading 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.