[Congressional Record Volume 147, Number 48 (Wednesday, April 4, 2001)]
[Extensions of Remarks]
[Pages E535-E536]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  INTRODUCTION OF THE MEDICARE MENTAL HEALTH MODERNIZATION ACT OF 2001

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Wednesday, April 4, 2001

  Mr. STARK. Mr. Speaker, today I join with Senator Wellstone and my 
House colleagues to introduce legislation that is long overdue. The 
Medicare Mental Health Modernization Act of 2001 does just what its 
title says--it updates and improves Medicare mental health benefits, 
removing the many roadblocks to treatment faced by seniors and people 
with disabilities.
  This comprehensive legislation modernizes Medicare mental health 
coverage in three important areas:
  Parity for Mental Health Services. Current benefit structure 
discriminates against people seeking treatment for mental health and 
substance abuse conditions. In effect, Medicare imposes a ``mental 
health tax'' by requiring a 50 percent co-pay for outpatient mental 
health services instead of the 20 percent co-pay required for most 
other Part B medical services. In addition, there is a 190 day lifetime 
cap on psychiatric hospital services--even though no similar cap on 
inpatient services exists for any other health condition. These 
discrepancies perpetuate the stigma surrounding mental illness and must 
be eliminated.
  Our bill would eliminate the discriminatory 190 day lifetime cap and 
reduce the 50 percent co-pay for outpatient mental health services to 
the 20 percent level enjoyed for other Part B medical services.
  Coverage of Community-Based Mental Health Services. Not only does our 
nation's largest healthcare program impose discriminatory limits and 
copayments, its overall mental health benefit package is outdated and 
inadequate. The net result is that seniors and people with disabilities 
don't have access to the

[[Page E536]]

latest, most cost-effective mental health treatments.
  In the past few decades, there have been tremendous advances in 
mental health diagnosis and treatment. We know that mental health 
conditions are like other health conditions. With appropriate 
treatment, some conditions can be resolved entirely while others 
require lifelong management. The same is true for physical illnesses 
like diabetes or multiple sclerosis. Furthermore, as the 1999 Surgeon 
General's report concludes, ``a wide variety of community-based 
services are of proven value for even the most severe mental 
illnesses.'' Yet with few meager exceptions, Medicare mental health 
benefits have remained virtually unchanged since they were enacted in 
1965.
  To correct these flaws, the Medicare Mental Health Modernization Act 
would allow beneficiaries to access a range of community-based 
residential and outpatient services that appropriately reflect the 
state-of-the-art in mental health treatment.
  For example, although inpatient psychiatric services remain 
important, community-based crisis programs provide an evidence-based 
alternative to institutional care. Recognizing that fact, our bill 
would create Medicare coverage for up to 120 days/year for intensive 
residential services, such as mental illness residential treatment 
programs and substance abuse treatment centers.
  In addition, for the relatively small percentage of Medicare 
beneficiaries with the most serious and disabling mental illnesses, 
this legislation would make available a range of intensive outpatient 
services. Research confirms that these innovative services provide 
necessary skill training and supports that help people with brain 
disorders, such as schizophrenia and bi-polar disorder, function 
better. In fact, costly inpatient hospitalizations can be reduced by as 
much as 60 percent. Examples of intensive outpatient services include 
Programs of Assertive Community Treatment (PACT), psychiatric 
rehabilitation, and intensive case-management.
  Improved Beneficiary Access to Medicare-Covered Services. The 
Medicare Mental Health Modernization Act would also address 
professional shortages and potentially discriminatory coverage criteria 
that can leave vulnerable beneficiaries unable to access care. 
According to the Surgeon General,

     the supply of well-trained mental health professionals also 
     is inadequate in many areas of the country, especially in 
     rural areas. Particularly keen shortages are found in the 
     numbers of mental health professionals serving . . . older 
     people.''

  The Medicare Mental Health Modernization Act addresses these 
professional shortages by allowing marriage and family therapists and 
mental health counselors who are licensed or certified at the state 
level to provide Medicare-covered services. It also ensures that 
clinical social workers can continue to provide psychotherapy in 
nursing homes by allowing them to bill Medicare directly for these 
services as psychiatrists and clinical psychologists can do. Finally, 
because coverage criteria for therapy services require beneficiaries to 
demonstrate ``continuing clinical improvement,'' our bill would mandate 
a study to determine whether these criteria discriminate against people 
with Alzheimer's disease and related mental illnesses.
  There is no question that our country's senior citizens and people 
with disabilities have significant mental health and substance abuse 
needs. Consider data from the 1999 Surgeon General's report on mental 
health and the 2001 Robert Wood Johnson report on substance abuse:

       Major depression is strikingly prevalent among older 
     people. In primary care settings, 37 percent of senior 
     citizens demonstrate symptoms of depression and impaired 
     social functioning. Furthermore, older people have the 
     highest rate of suicide of any age group--accounting for 20 
     percent of all suicide deaths.
       About 20 percent of individuals age 55 and older experience 
     specific mental disorders that are not part of normal aging. 
     Unrecognized and untreated depression, Alzheimer's disease, 
     anxiety, late-onset schizophrenia, and other mental 
     conditions can lead to severe impairment and even death.
       Older Americans tend to underutilize mental health 
     services--only 50 percent of those who acknowledge mental 
     health problems receive treatment.
       Approximately 17 percent of adults over 65 suffer from 
     addiction or substance abuse, particularly alcohol and 
     prescription drug 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.
       Nearly 1 out of every 4 Medicare dollars spent on inpatient 
     hospital care is associated with substance abuse.
       About 5 percent of American adults experience a serious 
     mental illness that is disabling with respect to employment, 
     self-care, and interpersonal relationships. In fact, nearly 
     90 percent of people with serious mental illnesses are 
     unemployed.
       Nearly one-third of non-elderly, disabled Medicare 
     beneficiaries have a primary diagnosis of mental illness.

  Policymakers on both sides of the aisle agree that Medicare's mental 
health benefits are woefully inadequate and out-of-date--yet none of 
the current Medicare reform proposals specifically address mental 
health. As a country, will we continue to stigmatize mental illness and 
deny elderly and disabled individuals access to mental health services 
that can improve their health and well-being? To me, the bottom line is 
clear--mental health modernization must be part of any fundamental 
Medicare reform.
  On a national level, there is positive movement in this direction. On 
January 1, 2001, an executive order brought parity to 9 million Federal 
employees, retirees, and their dependents--providing them with improved 
mental health benefits equal to those for physical conditions. Most 
states and even many large corporations now recognize that unequal 
coverage for mental illnesses is not only discriminatory, but costs 
more money in the long run.
  That's because untreated mental illness can lead to high cost 
hospitalization and crime--not to mention personal and family 
suffering, suicide, homelessness, lost productivity, and partial or 
total disability. These comprise the ``indirect'' costs of untreated 
mental illness. Together, these direct and indirect costs are 
tremendous. Yet over the past decade, spending for mental health care 
has declined relative to overall health spending and accounts for a 
mere 7 percent of total health expenditures.
  The Medicare Mental Health Modernization Act is an important step 
forward in providing comprehensive mental health coverage for senior 
citizens and people with disabilities. It ends Medicare's longstanding 
discriminatory mental health benefits and recognizes that state-of-the-
art mental health care takes place in the community. This bill will 
assure that the mental health needs of elderly and disabled Americans 
are more fully addressed.
  A range of mental health advocacy organizations representing 
consumers, family members, and professionals has endorsed this bill. 
These include: American Association of Geriatric Psychiatry; American 
Association of Marriage and Family Therapists; American Association of 
Pastoral Counselors;
  I urge my colleagues to join us in support of this important 
legislation.

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