II 109th CONGRESS 1st Session S. 927 IN THE SENATE OF THE UNITED STATES April 27, 2005 Mr. Corzine (for himself, Mr. Lautenberg, Mr. Sarbanes, Mr. Johnson, Ms. Landrieu, and Mr. Kennedy) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to expand and improve coverage of mental health services under the medicare program.

1.

Short title; table of contents

(a)

In general

This Act may be cited as the Medicare Mental Health Modernization Act of 2005. (b)

Table of contents

The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Findings. TITLE I—Establishing parity for mental health services Sec. 101. Elimination of lifetime limit on inpatient mental health services. Sec. 102. Parity in treatment for outpatient mental health services. TITLE II—Expanding coverage of community-based mental health services Sec. 201. Coverage of intensive residential services. Sec. 202. Coverage of intensive outpatient services. TITLE III—Improving beneficiary access to medicare-covered services Sec. 301. Excluding clinical social worker services from coverage under the medicare skilled nursing facility prospective payment system and consolidated payment. Sec. 302. Coverage of marriage and family therapist services. Sec. 303. Coverage of mental health counselor services. Sec. 304. Study of coverage criteria for alzheimer’s disease and related mental illnesses.

2.

Findings

Congress finds the following: (1)Older people have the highest rate of suicide of any population in the United States, and the suicide rate of that population increases with age, with individuals 65 and older accounting for 20 percent of all suicide deaths in the United States, while comprising only 13 percent of the population of the United States. (2)Disability due to mental illness in individuals over 65 years old will become a major public health problem in the near future because of demographic changes. In particular, anxiety, dementia, depression, schizophrenia, among other conditions, will all present special problems for this age group. (3)Major depression is strikingly prevalent among older people, with between 8 and 20 percent of older people in community studies and up to 37 percent of those seen in primary care settings experiencing symptoms of depression. (4)Anxiety disorders rival depression in their prevalence among older people with a rate of 11.4 percent in persons aged 55 and older. (5)Almost 20 percent of the population of individuals age 55 and older, experience specific mental disorders that are not part of normal aging. (6)Unrecognized and untreated depression, Alzheimer’s disease, anxiety, late-life schizophrenia, and other mental conditions can be severely impairing and may even be fatal. (7)Substance abuse, particularly the abuse of alcohol and prescription drugs, among adults 65 and older is one of the fastest growing health problems in the United States, with 17 percent of this age group suffering from addiction or substance abuse. While addiction often goes undetected and untreated among older adults, aging and disability makes the body more vulnerable to the effects of alcohol and drugs, further exacerbating other age-related health problems. Medicare coverage for addiction treatment of the elderly needs to recognize these special vulnerabilities. (8)The disabled are another population receiving inadequate mental health care through medicare. According to the Centers for Medicare & Medicaid Services, medicare is the primary health care coverage for the 5,000,000 nonelderly, disabled people on Social Security Disability Insurance. Up to 40 percent of these individuals have a diagnosis of mental illness. (9)The current medicare benefit structure discriminates against the millions of Americans who suffer from mental illness and maintains an outdated bias toward institutionally based service delivery. According to the report of the Surgeon General on mental health for 1999, intensive outpatient services, such as psychiatric rehabilitation and assertive community treatment, represent state-of-the-art mental health services. These evidence-based community support services help people with psychiatric disabilities improve their ability to function in the community and reduce hospitalization rates by 30 to 60 percent, even for people with the most severe mental illnesses.