Psychiatric Association's Council on Healthcare Systems and Financing, called on lawmakers and regulators to maintain those expansions and continue to reimburse mental health telehealth visits at the same rate as in-person visits, another pandemic innovation.
Older adults who seek psychiatric care tend to have more complex needs than younger adults, with more medical conditions, more disabilities, more potential side effects from medications, and fewer social supports, making their care time-consuming and challenging, he said.
"Although 1 in 4 Medicare recipients have some type of mental health condition, up to half don't receive treatment."
Several questions remain open as Medicare enacts these changes. The first is, "Will CMS pay mental health counselors and marriage and family therapists enough so they actually accept Medicare patients?" asked Beth McGinty, chief of health policy and economics at Weill Cornell Medicine in New York City. That's by no means guaranteed.
A second: Will Medicare Advantage plans add marriage and family therapists, mental health counselors, and drug addiction specialists to their networks of authorized mental health providers? And will federal regulators do more to guarantee that Medicare Advantage plans provide adequate access to mental health services? This kind of oversight has been spotty at best.
In July, researchers reported that Medicare Advantage plans include, on average, only 20% of psychiatrists within a geographic area in their networks. (Similar data is not available for psychologists, social workers, and psychiatric nurses.) When older adults have to go out-of-network for mental health care, 60% of Medicare Advantage plans don't cover those expenses, KFF reported in April. With high costs, many seniors just skip services.
Another key issue: Will legislation proposing mental health parity for Medicare advance in Congress? Parity refers to the notion that mental health benefits available through insurance plans should be comparable to medical and surgical benefits in key respects. Although parity is required for private insurance plans under the 2008 Mental Health Parity and Addiction Equity Act, Medicare is excluded.
One of the most egregious examples of Medicare's lack of parity is a 190-day lifetime limit on psychiatric hospital care, a feature that deeply affects members with serious conditions such as schizophrenia, severe depression, or post-traumatic stress, who often require repeated hospitalization. There is no similar curb on hospital use for medical conditions.
An upcoming Government Accountability Office report examining differences between the cost and use of behavioral health services and medical services in traditional Medicare and Medicare Advantage plans may give Congress some guidance, suggested Steinberg, of the Legal Action Center. That investigation is underway, and a date for the report's release hasn't been set.
But Congress can't do anything about the all-too-common assumption that seniors
feeling overwhelmed or depressed should "just grin and bear it." Kathleen Cameron, chair of the executive committee for the National Coalition on Mental Health and Aging, said "there's a lot more that we need to do" to address biases surrounding the mental health of older adults.
ABOUT THE AUTHOR:
Judith Graham writes the "Navigating Aging" column for KFF Health News. She has covered health care for more than 30 years. She's been an investigative reporter, national correspondent and senior health reporter at the Chicago Tribune and a regular contributor to The New York Times' New Old Age blog. Judith was the first topic leader on aging for the Association of Health Care Journalists. Her work has appeared in publications including Stat News, The Washington Post, and the Journal of the American Medical Association. She is a graduate of Harvard College and has a master's in journalism from Columbia University.
