Magazine article Behavioral Healthcare Executive

Celebrating Our Medicare Victory; It Took a Lot of Hard Work, but Congress Finally Acted to Eliminate the Higher Co-Pay for Mental Health Services

Magazine article Behavioral Healthcare Executive

Celebrating Our Medicare Victory; It Took a Lot of Hard Work, but Congress Finally Acted to Eliminate the Higher Co-Pay for Mental Health Services

Article excerpt

On July 9, the mental health and substance use care fields scored a major victory when the Senate passed by a margin of 69 to 30 (1 not voting) the Medicare Improvements for Patients and Providers Act of 2008. The House passed an identical bill (HR 6331) on June 24 by a margin of 355 to 59 (20 not voting). President Bush subsequently vetoed the bill. However, on July 15 the Congress overrode the veto by larger margins than the original vote: 383 to 41 in the House and 70 to 26 in the Senate. This action sustains very important gains for the mental health and substance use care fields.

The legislation phases out the discriminatory 50% co-pay for mental health ambulatory care under Medicare Part B over 6 years. After this period, the mental health co-pay will be 20%, the same as for all other illnesses. National data show that the discriminatory co-pay has driven many consumers into expensive inpatient care, into primary care, or away from mental healthcare entirely. Unlike most issues, the data supporting this legislation are very clear--allowing for a slam-dunk victory for the field.

The legislation also postpones scheduled cuts in Medicare funding to providers. This is important because cuts in provider payments drive providers away from serving the population covered by Medicare, about 44 million elderly and disabled persons. This number is expected to grow by about 35 million over the next 20 years. (An estimated 10,000 persons will reach age 65 each day over the next 10 years!)

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In addition, the legislation recommends the development of integrated mental health/ primary care systems for rural areas. The New Freedom Commission and the Institute of Medicine have called for integrated care.

The effort to eliminate the discriminatory 50% co-pay was long and arduous. In May 2003,I had the honor of briefing Senate and House staff on national Medicare data I had acquired from CMS for a long-term SAMHSA financing project. In 2007, the House Ways and Means Committee's Subcommittee on Health, chaired by Rep. Pete Stark (D-Calif), held a hearing at which testimony and data were presented in support of reform (See my June 2007 commentary on "Making the case for parity and Medicare reform"). At the same time, 17 national mental health and substance use care organizations formed a coalition to advocate for this specific reform. Subsequently, Stark attached the co-pay reform to the SCHIP bill, which was vetoed by President Bush. …

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