[Congressional Record Volume 144, Number 70 (Wednesday, June 3, 1998)]
[Extensions of Remarks]
[Page E985]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

[[Page E985]]



  MEDICARE+CHOICE MENTAL HEALTH COVERAGE ACCESS ASSURANCE ACT OF 1998

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Wednesday, June 3, 1998

  Mr. STARK. Mr. Speaker, I rise today to introduce the 
``Medicare+Choice Mental Health Coverage Access Assurance Act of 
1998.'' This important legislation seeks to provide Medicare 
beneficiaries with appropriate and medically necessary mental health 
coverage under managed care.
  Last year's Balanced Budget Act opened more managed care choices to 
Medicare beneficiaries through the establishment of the Medicare+Choice 
Program. In doing so, we enacted some patient protection measures for 
individuals enrolled or will be enrolled in Medicare managed care. 
However, because of managed care's history of putting more restrictive 
limits on mental health care compared to general health care, I believe 
that additional steps must be taken to ensure that Medicare patients 
with mental health needs will receive appropriate mental health care.
  The amendments to the Balanced Budget Act that I am introducing today 
would give Medicare consumers emergency care in the case of a suicide 
attempt, coordination of post-stabilization care, clear descriptions of 
mental health and substance abuse benefits, access to mental health 
specialists and to inpatient treatment.
  According to the Health Care Financing Administration, close to five 
million Medicare beneficiaries are mentally ill. Of these, 1.3 million 
are under age 65; they receive SSDI and Medicare due to a mental 
disability. The number of SSDI recipients diagnosed with a mental 
illness increased 17% between 1993 and 1995. And it is expected that 
the number of geriatric patients with mental disorders such as 
depression, anxiety, and Alzheimer's will grow rapidly in the coming 
years. To address these needs, Medicare spent close to four billion 
dollars on mental health services in calendar year 1994. Yet, the 
services presently received by Medicare beneficiaries are viewed by 
many as inadequate and fragmented.
  While one may expect capitated systems to better provide for a full 
continuum of mental health care and serve individuals with mental 
health needs better, experience with this sector to date has been 
mixed. In the public sector, states are struggling to address 
fundamental questions of coverage, access, quality, and mental health's 
coordination with the rest of health care as millions of mentally 
disabled Medicaid beneficiaries are moved into managed care systems. It 
is worth noting that many public purchasers are placing their mental 
health and addiction disorder treatment and prevention programs into 
the hands of private companies far more rapidly than their own 
contracting abilities or the capabilities of the managed care companies 
may warrant.
  Medicaid's transformation to managed care gives us reasons to proceed 
with caution. The federal government retains the ultimate 
responsibility of ensuring that taxpayers' money is well-spent and the 
mental health needs of Medicare beneficiaries are well-served if we are 
to turn their care over to private companies. This legislation that I 
am introducing today address these issues and requires the following 
minimum standards from health plans that wish to participate in 
Medicare.
  First, a patient should get the psychiatric emergency care he needs 
if he has made a suicidal attempt or has made serious threats to 
inflict harm to himself. It seems that some managed care companies do 
not take a suicidal attempt seriously enough. According to the report 
Stand and Deliver: Action Called to a Failing Industry, 1997 by the 
National Alliance for the Mentally Ill, five of the nine largest 
behavioral managed companies surveyed failed to provide a response that 
acknowledged a suicide attempt as a potentially deadly emergency 
requiring prompt attention.
  Second, should a patient show up in an emergency room in an emotional 
crisis and the managed care plan decides that he does not meet the 
criteria for an inpatient admission, the plan must still do what it 
takes to stabilize the patient. Treatment decisions should include a 
realistic assessment of the availability of community supports and 
other treatment setting options that would serve as an alternative to 
inpatient care such as partial hospitalization or acute diversion 
units.
  Third, Medicare beneficiaries are entitled to and should get a clear 
description of mental health and addictive disorder treatment benefits 
from health plans. This should include any front-end restrictions on 
utilization of mental health services such as premiums, co-insurance, 
deductibles, number of visits and days limits, and the range of 
services provided. In addition, plans should also disclose annual and 
lifetime limits on mental health spending. This would enable Medicare 
beneficiaries, and specifically those with mental disability, to make 
an informed choice of a plan that best serves their needs.
  Fourth, a Medicare+Choice plan should provide beneficiaries access to 
mental health and addiction specialists. This requirement is 
particularly important to the severely and persistently mentally ill 
geriatric patients, whose complex medical, psychiatric, and cognitive 
impairments are frequently left poorly attended to.
  Last of all, it must be emphasized that the treatment of serious 
brain disorders continues to require the availability of inpatient 
care. The decision to admit or to refuse a psychiatric hospital 
admission to a patient in distress can have grave and even life-
threatening consequences. Thus, these decisions must be made in close 
consultation with the physician who wishes to admit a patient with 
serious symptoms to a hospital setting.
  I urge my colleagues to join me in co-sponsoring this important and 
straightforward legislation. For too long, discussions of mental health 
and addictive disorders have been lost in the Medicare debate. The 
elderly and disabled Medicare beneficiaries with mental health needs 
are a vulnerable population. They deserve our attention and our 
commitment to provide them with the best care we possibly can.

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