Medicare Mental Health Services

Background

At least one in five older Americans has a mental health condition. Among MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). beneficiaries age 65 and older, the most common mental are depression, anxiety, dementia, and other neurocognitive impairments. By 2030, the number of older people with such disorders is expected to double.

Mental disorders seldom occur in isolation and can often lead to serious physical health issues. For example, depression is associated with increased risk of coronary heart disease and premature death. Depression also often co-occurs with substance abuse disorder and other chronic illnesses such as Alzheimer’s disease, cancer, and arthritis.

However, they are frequently undiagnosed or misdiagnosed in older patients. Older adults are more likely than younger adults to receive inappropriate or inadequate mental health services. One reason is that primary care practitioners—who provide most mental health care under MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). —have insufficient training in the assessment and treatment of mental disorders associated with aging. Although geriatric mental health assessment tools exist, their use is often not part of routine practice. Perceived social stigma and denial can also impede accurate diagnosis and treatment.

Many older people are reluctant to seek counseling to help them cope with the challenges of later life, such as bereavement, disability, loneliness, and isolation, which may explain why older Americans are disproportionately likely to die by suicide.

While MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). ’s coverage of mental health and substance abuse services has improved over the years, restrictions that do not apply to other health services remain. These include a lifetime limit of 190 days for psychiatric care in freestanding psychiatric hospitals. Despite growing evidence supporting the effectiveness of multi-disciplinary, community-based geriatric mental health treatment teams (e.g., physicians, social workers, nurses, psychologists, and pharmacists), MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). limits access to this type of care.

MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). covers some mental health-related preventive services with no cost-sharingThe share of insurance-covered costs that a person pays out of pocket, including deductibles, coinsurance, and copayments. It does not include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. , including annual screenings for depression and alcohol misuse screening. But coverage for subsequent services can be limited. For those who screen positive for alcohol misuse, MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). will cover four brief, face-to-face behavioral counseling interventions per year (see also Specific Needs and Services—Mental Health for a broader discussion of mental health issues).

MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). covers outpatient mental health services provided by physicians (especially psychiatrists), clinical psychologists, clinical social workers, clinical nurse specialistsRNs with advanced education and training in a specialized area of nursing practice. A CNS’s area of practice may be defined by medical subspecialty; population served (geriatric); setting, or type of care (e.g., psychiatric). , nurse practitionersAdvanced practice RNs provide a wide range of healthcare services. NPs often specialize by patient population, such as adult, geriatric, pediatric, and women’s health. They may also subspecialize in clinical areas such as oncology and dermatology. , and physician assistants. MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). does not cover treatment by licensed professional counselors. For beneficiaries in rural areas, MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). will pay only for mental health services delivered via telehealthThe use of electronic telecommunications technologies to deliver health care, health information, or health education at a distance. A related term, Telemedicine, generally indicates physician services. (video conference) from an approved location by a qualified mental health professional.

The Affordable Care Act ( ACAThe ACA—the shortened abbreviation for the Patient Protection and Affordable Care Act— is comprehensive health care reform legislation enacted by Congress and signed into law on March 23, 2010. ) made some significant improvements to MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). ’s mental health service coverage. For example, MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). Part D now covers barbiturates and benzodiazepines, which were originally excluded from that coverage. The ACAThe ACA—the shortened abbreviation for the Patient Protection and Affordable Care Act— is comprehensive health care reform legislation enacted by Congress and signed into law on March 23, 2010. also eliminated cost-sharingThe share of insurance-covered costs that a person pays out of pocket, including deductibles, coinsurance, and copayments. It does not include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. for certain MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). -covered preventive services and authorized the Centers for MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). & MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Services to add coverage of additional preventive services through the national coverage determination process.

Based on the large and growing number of older adults who misuse substances like alcohol and prescription drugs, demand for mental health and substance abuse services is also expected to grow with the aging of the baby-boom cohort. The anticipated increase in demand for such services may be difficult to meet because older adults already have a tremendous unmet need for them.

MEDICARE MENTAL HEALTH SERVICES: Policy

MEDICARE MENTAL HEALTH SERVICES: Policy

Access to mental health services

MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). should provide more adequate reimbursement for mental health and substance abuse services. It should eliminate the 190-day lifetime limit on inpatient psychiatric care in freestanding psychiatric hospitals under Part A.

MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). should expand the list of mental health professionals who can be reimbursed under MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). to cover all providers who are fully licensed by their state for independent practice.

MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). should expand its coverage of outpatient services that have been shown to help individuals with mental illnesses remain in the community.

CMS should ensure MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). beneficiaries’ access to appropriate, high-quality mental health and substance abuse services, such as outpatient services and partial hospitalization services, as well as ensure access to such preventive services as screening for depression and alcohol misuse.

CMS should ensure that MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). beneficiaries with mental health or substance abuse problems have access to appropriate services. This is particularly so for those residing in nursing homes or enrolled in managed care plans. Data collection and other oversight activities must preserve beneficiary privacy and confidentiality.