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Medicare expands list of accessible mental health professionals


Judith Graham | (TNS) KFF Health Guide

Lynn Cooper was going through a terrible time. After losing her job in 2019, she became deeply depressed. Then the COVID-19 pandemic hit and his anxiety skyrocketed. Then her beloved therapist — a marriage and household counselor — informed Cooper that she wouldn’t be able to see her once Cooper turned 65 and joined Medicare.

“I was shocked,” said Cooper, who lives in Pittsburgh and is determined, through counseling, to take care of her mental health. “I have always had the best medical insurance a person can have. Then I turned 65 and got Medicare, and immediately I had trouble finding mental health services.

The problem: For many years, Medicare only covered services provided by psychiatrists, psychologists, licensed scientific social workers, and psychiatric nurses. However, faced with growing demand and many individuals willing to pay for care privately, 45% of psychiatrists and 54% of psychologists do not participate in this system. Citing low funds and bureaucratic hassles, more than 124,000 behavioral health practitioners have opted out of Medicare — probably the most of any medical specialty.

As a result, older people who are anxious about their health deteriorating or depressed by the lack of family and friends have great difficulty finding professional help. The limitations of care are made even more acute by prejudices linked to mental illness and by ageism, which lead some health professionals to reduce the difficulties of older people.

Now, relief may be possible as a set of legislative and regulatory changes expand Medicare’s pool of behavioral health services. For the first time, starting in January, Medicare will allow marriage and family therapists and mental health counselors to provide services. This cadre of more than 400,000 professionals represents more than 40% of the licensed mental health workforce and is very important in rural areas.

Medicare would include up to 19 hours per week of intensive outpatient care as a benefit, improving navigation and peer support services for people with serious mental illnesses, and increasing mobile crisis services that could care for people at home or on the street. .

“As we emerge from the COVID-19 public health emergency, it is abundantly clear that our country must improve access to effective care and treatment for mental health and related dysfunction. substance use,” Meena Seshamani, deputy administrator of the Centers for Medicare & Medicaid Companies. , mentioned in a July press release.

Organizations that have advocated for improved Medicare mental health protections for years applaud the changes. “I think we’re hopefully at a turning point where we’ll start to see more access to mental health care and substance abuse care for older adults,” said Deborah Steinberg, senior policy attorney health at the Authorized Motion Center. in Washington, D.C.

For years, seniors in need of psychological support have encountered obstacles. Although one in four Medicare beneficiaries – as well as nearly 8 million people under 65 with severe disabilities – suffer from a mental health problem, nearly half do not receive treatment.

Cooper, now 68 and a behavioral health policy specialist at the Pennsylvania Association of Space Companies on aging, ran into Medicare limits when she tried to find a new therapist in 2020: “ The first problem I had was finding someone who took Medicare. . Most providers I contacted were not accepting new patients. When Cooper finally found a scientific social worker willing to see her, the lead time before a preliminary appointment was six months, a gap she describes as “extremely disruptive.”

New Medicare initiatives should make it easier for people in Cooper’s position to get care.

Supporters also emphasize the importance of expanded Medicare coverage for telehealth, including mental health care. Since the pandemic, seniors have been able to get these previously restricted services at home via cellphone or digital devices anywhere in the country, and requirements for in-person appointments every six months have been waived. But some of these flexibilities are set to expire at the end of next year.

Robert Trestman, chair of the American Psychiatric Association’s Council on Health Care Programs and Financing, called on lawmakers and regulators to consider these expansions and continue to reimburse mental health telehealth visits at the same rate. rate than in-person visits, another pandemic innovation.

Older adults seeking psychiatric care tend to have more complex needs than younger adults, with more medical problems, more disabilities, more potential adverse effects from medications, and less social support, making them long and difficult care, he said.

A number of open questions remain as Medicare implements these changes. The first is: “Will CMS pay mental health counselors and marriage and family therapists enough to actually accept Medicare patients?” asked Beth McGinty, head of health policy and economics at Weill Cornell Medication in New York. This is in no way guaranteed.

Second: Will Medicare Benefit plans add marriage and family therapists, mental health counselors, and substance abuse specialists to their licensed mental health service networks? And can federal regulators do more to ensure that Medicare Benefit plans provide sufficient access to mental health providers? This type of oversight has been spotty at best.

In July, researchers reported that Medicare Benefit plans covered an average of only 20% of psychiatrists in a geographic area of ​​their networks. (Related information is not available to psychologists, social workers, and psychiatric nurses.) When older adults must go out of network to obtain psychological health care, 60% of Medicare benefit plans do not cover these expenses, a reported KFF. in April. With excessive prices, many seniors simply avoid providers.

Another key challenge: Will laws proposing mental health parity for Medicare pass in Congress? Parity refers to the idea that mental health benefits accessible through an insurance policy should match medical and surgical benefits in key areas. Although parity is required for personal insurance policies under the Psychological Health Parity and Addiction Equity Act of 2008, Medicare is excluded.

Perhaps the most egregious example of Medicare’s lack of parity is the lifetime limitation of psychiatric inpatient care to 190 days, a feature that profoundly affects members suffering from critical conditions such as schizophrenia, extreme depression, or post-traumatic stress disorder. traumatic, which generally require repeated hospitalizations. There is no comparable limit to the use of hospitals for medical situations.

An upcoming report from the Government Accountability Workplace examining differences between associated rates and use of behavioral health services and medical providers in traditional Medicare and Medicare Benefit plans could provide some direction for Congress, said Steinberg, of the Center for action authorized. This investigation is ongoing and a launch date for the report has not been set.

However, Congress can do nothing about the all-too-common assumption that older people who feel overwhelmed or depressed should “just grin and bear it.” Kathleen Cameron, chair of the core committee of the National Coalition on Psychological Health and Aging, said “we still need to do a lot more” to combat stigma surrounding older people’s mental health.

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We look forward to hearing from readers about the questions you’d like answered, the problems you’ve had with your care, and the advice you need to navigate the health care system. Go to kffhealthnews.org/columnists to submit your requests or suggestions.

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(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism on health issues and is one of KFF’s primary work units – the independent source health policy research, surveys and journalism.)

©2023 KFF Health Information. Distributed by Tribune Content Company, LLC.


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