Medicare rule changes allow more mental health practitioners

Lynn Cooper is going through a bad time. After losing her job in 2019, she fell into a deep depression. When the epidemic hit in early 2020, her anxiety reached its peak. Then her beloved therapist, a marriage and family counselor, told Cooper she would no longer be able to see her once he turned 65 and signed up for Medicare.

“I was shocked,” said Cooper, who lives in Pittsburgh. “I’ve always had the best health insurance a person could have. Then I turned 65 and went on Medicare, and all of a sudden I had trouble accessing mental health services.”

For decades, Medicare covered only mental health services provided by psychiatrists, psychologists, licensed clinical social workers, and psychiatric nurses.But as demand increases and many people are willing to pay for care privately, 45% of psychiatrists and 54% of psychologists are not participating Medicare is a federal insurance system that provides approximately 65 million elderly or disabled people.

More than 124,000 behavioral health practitioners have opted out of Medicare — the most of any medical specialty — citing low pay and bureaucratic hassles.

As a result, it can be difficult for older adults who are worried about their deteriorating health or who are depressed about losing family members and friends to seek professional help. Barriers to care are compounded by prejudice and ageism related to mental illness, leading some health professionals to minimize the suffering of older adults.

Now, as legislative and regulatory changes expand the scope of Medicare behavioral health providers, some relief may be on the way. Starting in January, Medicare will allow marriage and family therapists and mental health counselors to provide services for the first time. This cadre of more than 400,000 professionals represents more than 40 percent of the licensed mental health workforce and is particularly important in rural areas.

Medicare also added up to 19 hours per week of intensive outpatient care as a benefit, improved navigation and peer support services for people with serious mental illness, and expanded mobile crisis services that can treat people in their homes or on the streets. Serve.

Mental health changes related to the pandemic

“As we emerge from the COVID-19 public health emergency, it is abundantly clear that our nation must improve access to effective mental health and substance use disorder treatment…and care,” said Meena Seshamani, deputy director of the Centers for Medicare and Medicaid Services. ”, said in a statement in July.

Organizations that have advocated for years to improve Medicare mental health coverage applauded the changes. “I think we’re at a tipping point where we’re going to start to see more access to mental health and substance use disorders for older adults,” said Deborah Steinberg, senior health policy attorney at the Washington Legal Action Center. Nursing.”

For years, seniors needing mental health assistance have encountered barriers. Although an estimated one in four Medicare beneficiaries suffers from a mental health problem, as many as half do not receive treatment.

Cooper, 68, a behavioral health policy specialist at the Pennsylvania Association of Area Agencies on Aging, ran into Medicare restrictions when she tried to find a new therapist in 2020: “The first problem I had was Find someone who accepts Medicare. Many providers I contacted are not accepting new patients.”

When Cooper finally found a clinical social worker willing to see her, the wait time for an initial appointment was as long as six months, a period she describes as “very stressful.”

The new health insurance plan should make it easier for people like Cooper to get care.

Advocates also point to the importance of expanded Medicare coverage for telemedicine, including mental health care.

Since the pandemic, seniors can access these previously restricted services at home by phone or digital device from anywhere in the country, and the requirement for in-person appointments every six months has been waived. But some of those flexibilities are set to expire at the end of next year.

Robert Trestman, chairman of the American Psychiatric Association’s Committee on Health Systems and Financing, called on lawmakers and regulators to maintain these expansions and continue to reimburse mental health telemedicine visits at the same price as in-person visits. Another pandemic innovation.

Trestman said older adults seeking psychiatric care tend to have more complex needs than younger adults, with more medical conditions, more disabilities, more potential side effects of medications and less social support that make their Care can be time-consuming and challenging.

As Medicare implements these changes, several questions remain unanswered. First, “Will CMS pay mental health counselors and marriage and family therapists enough so that they actually accept Medicare patients?” said Beth McGinty, director of health policy and economics at Weill Cornell Medical College in New York. . This is by no means guaranteed.

Second, will Medicare Advantage plans add marriage and family therapists, mental health counselors, and addiction specialists to their network of authorized mental health providers? Will federal regulators do more to ensure that Medicare Advantage plans provide adequate mental health services? This oversight has been spotty at best.

In July, researchers reported that the average Medicare Advantage plan included only 20% of the psychiatrists in a geographic area in its network. (Similar data was not available for psychologists, social workers and psychiatric nurses.) KFF reported in April that when seniors must go out-of-network for mental health care, 60% of Medicare Advantage plans don’t cover those costs. Many seniors skip services due to high costs.

Another key question: Will legislation proposing mental health parity in Medicare advance in Congress? Parity means that mental health benefits offered through insurance plans should be comparable in key respects to medical and surgical benefits.

Although the Mental Health Parity and Addiction Equity Act of 2008 requires parity among private insurance plans, Medicare is excluded.

One of the most egregious examples of Medicare’s lack of equity is the 190-day lifetime limit on psychiatric hospital care. There are no similar restrictions on medical use in hospitals.

Steinberg said an upcoming report from the Government Accountability Office examining the differences in the cost and use of behavioral health services and medical services in traditional Medicare and Medicare Advantage plans could provide some guidance to Congress. The investigation is ongoing and a release date for the report has not yet been set.

But Congress can do little about the common assumption that seniors who feel overwhelmed or depressed should “smile and bear it.” “We still have a lot of work to do” to address stigma surrounding older adults’ mental health, said Katherine Cameron, executive committee chair of the National Alliance on Mental Health and Aging.

KFF Health NewsFormerly known as Kaiser Health News or KHN, it is a national newsroom specializing in in-depth journalism on health issues and is one of KFF’s core operations.

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