Medicare Reform Bill Seeks Mental Health Parity

A section of the legislation that has stirred controversy would expand the number of mental health professionals eligible to provide services through Medicare to include clinical social workers, licensed professional mental health counselors, and licensed marriage and family counselors. According to both Wellstone and Stark, this provision was meant to address “a growing shortage of qualified mental health professionals serving older Americans.”

While APA strongly supports most of the bill’s provisions, the addition of marriage and family therapists and mental health counselors as eligible providers of Medicare services raised significant concerns.

“We believe there are quality-of-care issues associated with coverage of marriage and family therapists and the term mental health counselors,” Jay Cutler, J.D., APA’s director of government relations, told Psychiatric News. “We strongly believe that Medicare’s underlying structural discrimination [against psychiatric care] should be addressed before Congress considers adding new providers to the Medicare list.”

Despite these reservations, Cutler reiterated APA’s strong praise for the rest of the bill. “The Stark-Wellstone bill is nothing short of a complete overhaul of Medicare’s antiquated and outmoded coverage of treatment for mental illness,” he said.

APA staff were invited to work closely with Stark’s and Wellstone’s staffs during development of the bill and were successful at recommending changes to the draft legislation. “The new bill is a major step forward from similar legislation introduced in the last Congress,” Cutler said. “We were grateful that many of APA’s suggestions were adopted.”

The bill has won strong support from professional associations and patient-advocacy groups.

Stephen Bartels, M.D., president of the American Association for Geriatric Psychiatry (AAGP), praised the new legislation, saying that “the bill aims to eliminate discrimination toward seniors who seek treatment for Alzheimer’s disease, late-life depression, and other mental illnesses. Arbitrary limitations on mental health services victimize an already vulnerable population and prevent them from having equal access to treatments that work,” Bartels told the press at a briefing announcing the introduction of the bill.

“We [AAGP] have concerns, just as APA does,” Bartels told Psychiatric News. “But what this bill does in getting rid of discriminatory copays and limits on care is such a giant step forward that it needs our full support. With the stipulations, which by the way were hard fought by APA, that marriage and family counselor and mental health counselor services must be referred by a physician, the benefits of this bill far outweigh those concerns.”

Geriatric mental health services are woefully understaffed in this country, said Bartels, who is medical director for the State of New Hampshire Division of Behavioral Health and codirector of the Behavioral Health Policy Institute at Dartmouth Medical School. For so long, he explained, access has been limited or beyond the financial means of most seniors. Expanding the availability of services, Bartels told Psychiatric News, through the use of nonphysician professionals under the supervision of a physician, is an acceptable way to make much needed services more accessible to the millions of senior citizens covered by Medicare.

Also supporting the bill were the National Mental Health Association, National Alliance for the Mentally Ill, and American Psychological Association, among others.

“Policymakers on both sides of the aisle agree that Medicare’s mental health benefits are woefully inadequate and out of date,” said Stark, who believes the prospects for passage of the bill are good. “Yet none of the current Medicare reform proposals specifically addresses mental health. It is time to stop stigmatizing mental illness and restricting access to mental health services that can improve the health and well-being of our nation’s elderly and disabled.”

Wellstone sees only one possible hurdle that could derail passage of the bill—cost. Estimates have placed the cost of the proposed changes at around $1 billion annually.

“But, you know,” Wellstone said, “you either pay a billion up front to help people get better, or you pay numerous billions down the road in both the direct and indirect costs of them not getting well. To me, it’s a rather straightforward dilemma.”