Medicare Mental Health Research Articles

A Case of the Tail Wagging the Dog: The Medicare Mental Health Coverage Gap and Its Impact on Providers and Beneficiaries

Nearly one in four Medicare beneficiaries have been diagnosed with mental health or substance use disorders, and research indicates this population responds well to mental health treatment. However, Medicare policy omits licensed mental health counselors (LMHCs) and licensed marriage and family therapists (LMFTs) as approved providers, exacerbating an existing national provider shortage. Emerging research demonstrates that the provider omission, referred to as the Medicare mental health coverage gap (MMHCG), profoundly impacts excluded providers and the communities they serve. This paper represents a synthesis of the most current scholarship on Medicare research, policy, and advocacy. In particular, we explore three ways the MMHCG impacts providers and beneficiaries alike: limiting provider choices, thwarting continuity of care, and creating challenging decisions for beneficiaries and providers. Our aim is to help mental health counselors better understand and navigate the MMHCG and aid in advocacy efforts for legislation to include LMHCs and LMFTs as approved Medicare providers.

Paying the price – out-of-pocket payments for mental health care in Australia.

Objective This study set out to present data on out-of-pocket payments for Medicare mental health services provided by general practitioners (GP), psychiatrists, clinical psychologists and other psychologists, to explore how much is spent on out-of-pocket payments for mental health; if any trends could be seen; and what variations exist across regions. Methods We performed secondary analysis of publicly available data on Medicare-subsidised GP, allied health and specialist health care across Australia. We merged and interrogated data covering the period 2013-19 and 2019-21 to create a data set covering eight full years of Medicare mental health services, arranged by profession and by region. Results Out-of-pocket payments for mental health care in Australia have been rising consistently over the period 2013-21, at a considerably faster rate than overall expenditure on mental health care. There is wide variation in out-of-pocket payments depending on where you live. Conclusions The impact of out-of-pocket payments on community access to mental health care is growing. This has implications, especially in poorer communities, for access to care. This should be an important consideration taken as the Australian Government considers next steps in national mental health reform, including the Better Access Program, currently under evaluation.

The impact of excluded providers on Medicare beneficiaries’ mental health care

AbstractMental health conditions are relatively common among Medicare beneficiaries. Yet, Medicare provider eligibility was last updated in 1989, raising concerns about beneficiaries’ access to mental health care in the United States. Beneficiaries are currently restricted from accessing mental health services provided by licensed professional counselors and licensed marriage and family therapists. Little is known about the impact of this Medicare mental health coverage gap (MMHCG) on Medicare beneficiaries. Hermeneutic phenomenology was used to analyze semistructured interviews with 18 beneficiaries who had attempted to access mental health care but were limited due to the MMHCG. Three themes emerged: (a) exasperating experiences with the MMHCG, (b) the MMHCG compounds barriers to mental health care, and (c) Medicare as a flawed system. These findings suggest current Medicare mental health policy interferes with beneficiaries’ access to needed mental health services. Implications for the counseling profession are described.

Denials, Surprise Charges, Starting Over: How Medicare Recipients Navigate the Medicare Mental Health Coverage Gap

Medicare is the primary insurance provider for approximately 51 million older adults, including those who seek mental health care. Medicare provider eligibility was last updated in 1989, and approximately one-third of the graduate-level mental health workforce (i.e., Licensed Professional Counselors and Licensed Marriage and Family Therapists) is excluded from Medicare, despite these professionals participating in Medicaid, TRICARE, the Veterans Administration, and private insurance plans. This Medicare mental health coverage gap (MMHCG) raises concerns about older adults’ access to mental health care, resulting in a policy misalignment between Medicare’s provider regulations and a growing number of older adults seeking mental health care. However, little is known about the precise impact of the MMHCG. To better understand how the MMHCG impacts older adults, we interviewed 17 Medicare-insured individuals about their experiences accessing mental health services. Using a phenomenological framework to analyze our data, we found that Medicare recipients described several consequences, such as: 1) a detrimental impact on their mental health and well-being; 2) concerns about having to start over with new providers due to commencing mental health treatment only to have services interrupted once the provider is no longer Medicare-reimbursable; and 3) relying on pro bono services from Medicare-excluded providers with uncertainty about the long-term sustainability of these arrangements. The presenters will describe how these findings fit within the current Medicare mental health service context, including the direct impact on older adults’ mental health. Discussion will also focus on policy implications of the findings and possible solutions for addressing the MMHCG.

The impact of the Medicare mental health coverage gap on rural mental health care access.

The impact of the Medicare mental health coverage gap on rural mental health care access.

APA: Medicare Mental Health Access Act would remove barriers to care

The American Psychological Association (APA) led 38 national organizations representing groups including consumers, providers, the aging, people with disabilities, veterans and farmers in supporting a bill to improve Medicare patients' access to mental and behavioral health services provided by psychologists. The legislation, H.R. 884, the Medicare Mental Health Access Act, was also endorsed by the Kennedy Forum, a key mental health and substance use organization led by former Rep. Patrick Kennedy, an APA news release stated Sept. 10. “In the midst of a global pandemic, the mental health care needs of our country have never been more acute,” said APA CEO Arthur C. Evans Jr., Ph.D. “It's essential that people be able to access mental health treatment when they need it, now and in the future.” Psychologists are key to meeting the demand for behavioral health services, providing not only psychotherapy and behavioral health care, but also psychological and neuropsychological testing and help for patients managing physical health conditions, Evans said. “This legislation would treat psychologists on par with other health care providers who aren't physicians, including chiropractors, optometrists, dentists and podiatrists,” he added.

Geller Testifies on MH Needs During Pandemic and Beyond

Back to table of contents Previous article Next article CommunityFull AccessGeller Testifies on MH Needs During Pandemic and BeyondKatie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:29 Jul 2020https://doi.org/10.1176/appi.pn.2020.8a10AbstractAPA President Jeffrey Geller, M.D., M.P.H., emphasized the ways telehealth has allowed Americans who might otherwise be cut off from mental health services during the pandemic to receive treatment.During a virtual hearing of the U.S. House Committee on Energy and Commerce Subcommittee on Health on June 30, APA President Jeffrey Geller, M.D., M.P.H., urged Congress to take action to curb the mental health impact of the COVID-19 pandemic.“We expect that, even after the infectious aspect of this pandemic is over, we’re going to have a mental health pandemic that could go on for quite some time,” Geller told the subcommittee.The hearing, titled “High Anxiety and Stress: Legislation to Improve Mental Health During Crisis,” addressed 22 pieces of legislation related to mental health care pending before Congress. Geller expressed APA’s support for legislation that would achieve the following:Require the Department of Health and Human Services to collect, analyze, and make publicly available data on race and ethnicity related to COVID-19 testing, hospitalization, and mortality as well as the mental health effects of the pandemic.Enforce the parity law, which requires insurers to cover mental health at the same levels as other medical care.Continue expanded telehealth rules beyond the COVID-19 emergency.Strengthen congressional efforts to prevent suicide.Ensure that patients who present in the Emergency Department with suicidal ideation or who have attempted suicide are screened and referred to appropriate mental health treatment.Boost resources for call centers, 24/7 mobile crisis units, and crisis stabilization programs.Geller especially expressed APA’s support for the Telemental Health Expansion Act of 2019 (HR 5201), introduced by Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio). The legislation would permanently exempt tele-mental health services from Medicare’s geographic restrictions, such as requiring patients to travel to a qualifying “originating site” for appointments.“About 65% [of psychiatrists] had not previously used telehealth, and now 85% are using telehealth for about three-quarters of their patients,” Geller told the committee. “The combination of allowing for visual as well as telephone-only services is very important as you have many patients who have no idea how to use any electronic equipment whatsoever.”He also highlighted the Mental Health Parity Compliance Act (HR 3165), sponsored by Reps. Katie Porter (D-Calif.), Gus Bilirakis (R-Fla.), and Donald Norcross (D-N.J.). This legislation would ensure that health insurance plans comply with the Mental Health Parity and Addiction Treatment Act of 2008.The COVID-19 crisis has unmasked clear racial disparities and inequities, Geller told the subcommittee. “We cannot begin to remedy systemic issues within health care access and delivery if we do not first have quantifiable data from which to inform our policy proposals,” he said in his written testimony.During the question-and-answer portion of the hearing, Geller stressed that he believes a campaign is urgently needed to reduce prejudice and discrimination toward people with mental illness and called on Congress to help such an effort.“We use the word ‘stigma,’ but I think it’s actually an unfortunate word,” he said. “It is prejudice and discrimination to think that if someone has a mental illness, they’re not capable of functioning.”Geller also addressed the issue of domestic violence and sexual assault potentially increasing as people find themselves required to stay at home while living with a perpetrator of violence. “People are stuck at home together, they’re afraid to report, or they’re afraid to leave home to report,” Geller said. “We have to be cognizant of this phenomenon and specifically address it. It has not been talked about a great deal.”The only bill addressed during the hearing that APA opposed was the Medicare Mental Health Access Act (HR 884), introduced by Rep. Judy Chu (D-Calif.), which would define psychologists as physicians under Medicare. In his written testimony, Geller noted that the bill “would further fragment care by creating unnecessary and dangerous silos between all health care providers who should be working collaboratively.” APA strongly encourages members to contact lawmakers to express their opposition to this legislation.Geller testified along with former Rep. Patrick Kennedy, founder of the Kennedy Forum; Arthur C. Evans Jr., Ph.D., CEO of the American Psychological Association; and Arriana Gross, a member of the National Youth Advisory Board of the Sandy Hook Promise Students Against Violence Everywhere Promise Club. ■“High Anxiety and Stress: Legislation to Improve Mental Health During Crisis” is posted here.Geller’s written testimony is posted here.More information on contacting your U.S. representative to express your opposition to HR 884 is posted here. ISSUES NewArchived

The Impact Of Medicare's Mental Health Cost-Sharing Parity On Use Of Mental Health Care Services.

Before the implementation of cost-sharing parity in Medicare, beneficiaries faced higher cost sharing for mental health services than for other medical services. The Medicare Improvements for Patients and Providers Act of 2008 phased in cost-sharing reductions in Medicare for outpatient mental health services in the period 2010-14. Using data for 2006-15 from the Medical Expenditure Panel Survey and difference-in-differences analyses, we assessed whether this reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. We compared people with Medicare and with private insurance before and after parity implementation. Medicare beneficiaries' use of psychotropic medication increased after the implementation of cost-sharing parity, but we did not detect a change in visits. Changes in the use of psychotropic medications were greater among people with probable serious mental illness and among Medicare beneficiaries who did not report having supplemental coverage. The increased medication use could signal improvements in mental health care access among Medicare beneficiaries, especially among the subgroups most likely to benefit from the policy change.

The Medicare Mental Health Coverage Gap: How Licensed Professional Counselors Navigate Medicare-Ineligible Provider Status

The Medicare Mental Health Coverage Gap: How Licensed Professional Counselors Navigate Medicare-Ineligible Provider Status

MEDICARE IS THE LAST HOLDOUT: EXAMINING THE IMPACT OF MEDICARE POLICY ON OLDER ADULTS’ ACCESS TO MENTAL HEALTH CARE

Medicare is the primary insurance provider for approximately 59 million Americans, and the number of beneficiaries is expected to surpass 80 million by 2030. Currently, Medicare regulations allow psychiatrists, psychologists, clinical social workers, and psychiatric nurses to provide mental health services. These providers were last updated in 1989 with passage of the Omnibus Budget Reconciliation Act of 1989. Since that time, the mental health marketplace has changed dramatically, and Medicare beneficiaries are unable to access care from approximately 200,000 graduate-level mental health professionals with similar training to eligible Medicare providers. There is evidence that this Medicare mental health coverage gap (MMHCG) impacts both providers and beneficiaries. For example, some beneficiaries may begin treatment only to have services interrupted, or stopped altogether, once the provider is no longer able to be reimbursed by Medicare. We surveyed 6,550 members of the American Counseling Association, including 3,815 who identified themselves as practicing counselors. These individuals work in diverse contexts (e.g., community mental health agencies, private practice, and integrated care settings). Survey results indicated that a significant number of practicing counselors turn away or refer Medicare beneficiaries who seek mental health care due to the MMHCG. In-depth interviews were also completed with eight licensed mental health professionals who detailed the challenges they and their clients experienced. Participants perceived a discrepancy between Medicare’s intended aims to promote health and provider restrictions that were confusing and frustrating to navigate. Participants concluded that the MMHCG has a negative impact on older adult clients.

Medicare and mental health coverage: An analysis of how current Medicare policy encumbers the Medicare-insured

ABSTRACTThis study illuminates the impact of existing Medicare mental health provider policy on individuals seeking counseling services. The authors applied qualitative content analysis to data provided by members of the American Counseling Association. Two superordinate themes, current Medicare policy encumbers the Medicare-insured and creates a unique hardship on specific client populations are presented in depth in this article, in addition to several emergent themes. The results suggest that current Medicare policy has far-reaching undesirable consequences for the Medicare-insured.

Mental health and Victorian Aboriginal people: what can data mining tell us?

Nationally, Aboriginal people experience high levels of psychological distress, primarily due to trauma from colonisation. In Victoria, Aboriginal Community Controlled Health Organisations (ACCHOs) provide many services to support mental health. The aim of the present study was to improve understanding about Victorian Aboriginal people and mental health service patterns. We located four mental health administrative datasets to analyse descriptively, including Practice Health Atlas, Alcohol and Other Drug Treatment Service (AODTS), Kids Helpline and Close The Gap Pharmaceutical Scheme data. A large proportion of the local Aboriginal population (70%) were regular ACCHO clients; of these, 21% had a mental health diagnosis and, of these, 23% had a Medicare Mental Health Care Plan (MHCP). There were higher rates of Medicare MHCP completion rates where general practitioners (GPs) had mental health training and the local Area Mental Health Service had a Koori Mental Health Liaison Officer. There was an over-representation of AODTS episodes, and referrals for these episodes were more likely to come through community, corrections and justice services than for non-Aboriginal people. Aboriginal episodes were less likely to have been referred by a GP or police and less likely to have been referrals to community-based or home-based treatment. There was an over-representation of Victorian Aboriginal calls to Kids Helpline, and these were frequently for suicide and self-harm reasons. We recommend primary care mental health programs include quality audits, GP training, non-pharmaceutical options and partnerships. Access to appropriate AODTS is needed, particularly given links to high incarcerations rates. To ensure access to mental health services, improved understanding of mental health service participation and outcomes, including suicide prevention services for young people, is needed.

Senators Question Federal Oversight of Medicare Mental Health Claims

Senators Question Federal Oversight of Medicare Mental Health Claims

Senate Committee Solicits Input on State of MH System

Back to table of contents Previous article Next article Government NewsFull AccessSenate Committee Solicits Input on State of MH SystemLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:15 Mar 2013https://doi.org/10.1176/appi.pn.2013.3b13AbstractExperts tell a Senate committee that the mental health system is overburdened, many patients don’t get needed help, and earlier and improved detection could change that reality.The Senate Health, Education, Labor, and Pensions (HELP) Committee, convened a meeting January 24 to discuss—for the first time in six years—the mental health of Americans. Prompted by the Newtown, Conn., school shooting and in anticipation of the changes the Affordable Care Act will bring about, committee members solicited input at the hearing they dubbed “Assessing the State of America’s Mental Health System.”“It seems to me that the questions before us are ‘who needs help’ and ‘who’s there to provide the help’,” said Sen. Lamar Alexander (R-Tenn.), the committee’s ranking member.Pamela Hyde, J.D., administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), was the first to provide testimony. “Behavioral health is a public-health issue, not a social issue, and it can be tackled and addressed with an effective public-health approach,” she said, while noting that SAMHSA’s National Survey on Drug Use and Health indicates that only 38 percent of adults with diagnosable mental health problems and only 11 percent of those with diagnosable substance use disorders receive treatment.“Prevention works, treatment is effective, and people do, in fact, recover,” she stressed, but obstacles including cost, access, and recognition of mental health disorders are the primary reasons treatment is not received by many who need it. Hyde pointed to upcoming changes associated with the Affordable Care Act that will extend the reach of mental health treatment to more Americans, saying “Medicaid is already the largest payer of mental health services, and the Affordable Care Act will extend Medicaid coverage to as many as 17 million hardworking Americans.”Thomas Insel, M.D., director of the National Institute of Mental Health (NIMH), also presented testimony and emphasized that most mental disorders begin early in life, yet patients often wait years for diagnosis and treatment. “The lesson we have learned from cancer and heart disease, diabetes and AIDS, is that the secret to having the best outcomes is early detection and early intervention…yet we don’t do that.” Moving forward, NIMH will support research on earlier diagnosis and quicker delivery of appropriate treatment, be it behavioral or pharmacological, he said. Medical Director James H. Scully Jr., M.D., submitted testimony on behalf of APA. “This hearing comes at a critical time when our leaders in government are faced with difficult choices about where to allocate limited resources,” he noted. “Nevertheless, I believe the current state of our nation’s mental health system is weak and demands immediate and significant attention by Congress and the administration.” Scully’s testimony presented five key areas through which the mental health system could be strengthened to ensure the mental health and well-being of all Americans:Mental Health Parity. APA urges issuance of a final rule on the Mental Health Parity and Addiction Equity Act of 2008. In the absence of a final rule, APA is concerned that access to critical mental health services will be jeopardized for millions of Americans. APA also supports reintroduction of the Medicare Mental Health Inpatient Equity Act, which would increase access to coverage for the most seriously mentally ill people. A Commission on Mental Health. APA supports the idea of a new commission—either presidential or congressional—to conceptualize how the nation’s mental health system can meet the needs of all Americans. Investing in Existing Mental Health System Components. APA supports investment in biomedical research, initiatives to develop and implement new treatments for addiction, and state block grants for mental health and substance use activities, suicide prevention, and jail-diversion programs for people with mental illness. Support for Graduate Medical Education. The ability of the U.S. mental health system to deliver high-quality care in a coordinated and cost-effective manner is dependent upon an appropriately trained workforce. As a physician specialty society, APA strongly supports the preservation of funding for both direct graduate medical education and indirect graduate medical education, programs that support 16,000 residencies each year. Early Intervention and Prevention Services for Youth. As a vulnerable population, children and adolescents are especially in need of early intervention and prevention services.Scully also brought to the committee’s attention the initiative APA launched through the American Psychiatric Foundation, called “Typical or Troubled?,” to train school personnel to make the distinction between students who are “just being adolescents” and students who demonstrate early signs of mental illness, saying “this program represents the type of early intervention and prevention strategy that could serve as a national model.” ■A video of the committee hearing as well as written testimony are posted at http://www.help.senate.gov/hearings/hearing/?id=b2048a10-5056-a032-529c-340d7ae5f237. Scully’s testimony is posted at http://www.psychiatry.org/advocacy--newsroom/advocacy/apa-submits-testimony-to-congress-on-the-state-of-americas-mental-health-system. ISSUES NewArchived

Table of Contents

AbstractPayroll Tax Law Does Not Bode Well for Medicare Mental Health RecipientsAlabama to Close State Hospitals in Move to Transform MH SystemCalifornia Insurer's Outpatient Review is Subject of SuitCARF Releases Accreditation Standards for Student CounselingMichigan Advocates Push for MH Inclusion in Autism BillBriefly NotedState NewsComing up

Medicare Mental Health Parity: A High Potential Change that is Long Overdue

Recent changes in legislation regarding mental health parity in Medicare will revolutionize payment for mental health care and delivery systems. This commentary discusses why this policy change was essential to promote adequate care for populations served by Medicare and to address expected changes in beneficiary, provider, and plan behavior as more equitable payments by Medicare are implemented.

Congress Ends Medicare's Mental Health Copay Bias

Congress Ends Medicare's Mental Health Copay Bias

Suicide-Prevention Bill Would End Discriminatory MH Copay

Suicide-Prevention Bill Would End Discriminatory MH Copay

APA Tells Congress: End Medicare's Higher Copay for MH Treatment

APA Tells Congress: End Medicare's Higher Copay for MH Treatment

APA Advocacy Agenda Focuses on Access Issues

APA Advocacy Agenda Focuses on Access Issues