[Congressional Record Volume 153, Number 51 (Friday, March 23, 2007)]
[Extensions of Remarks]
[Pages E632-E633]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        INTRODUCING THE MEDICARE MENTAL HEALTH MODERNIZATION ACT

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Friday, March 23, 2007

  Mr. STARK. Madam Speaker, I rise today with my colleagues Jim Ramstad 
of Minnesota and Patrick Kennedy from Rhode Island to introduce the 
Medicare Mental Health Modernization Act, a bill to provide mental 
health parity in Medicare. I have introduced a version of this bill in 
every Congress since 1994. Perhaps this time we can actually enact it.
  Medicare's mental health benefit is fashioned on treatments provided 
in 1965, but mental health care has changed dramatically over the last 
42 years. Medicare limits inpatient coverage at psychiatric hospitals 
to 190 days over an individual's lifetime. In addition, beneficiaries 
are charged a discriminatory 50 percent coinsurance for outpatient 
psychotherapy services, compared to 20 percent for physical health 
services.
  The Medicare Mental Health Modernization Act eliminates this blatant 
mental health discrimination under Medicare and modernizes the Medicare 
mental health benefit to meet today's standards of care.
  This bill is long overdue. One in five members of our senior 
population displays mental difficulties that are not part of the normal 
aging process. In primary care settings, more than a third of senior 
citizens demonstrate symptoms of depression and impaired social 
functioning. Yet only one out of every three mentally ill seniors 
receives the mental health services he/she needs. Older adults also 
have one of the highest rates of suicide of any segment of our 
population. In addition, mental illness is the single largest 
diagnostic category for Medicare beneficiaries who qualify as disabled.
  There is a critical need for effective and accessible mental health 
care for our Medicare population. Recent research has found a direct 
relationship between treating depression in older adults and improved 
physical functioning associated with independent living. Unfortunately, 
the current structure of Medicare mental health benefits is inadequate 
and presents multiple barriers to access of essential treatment. This 
bill addresses these problems.
  The Medicare Mental Health Modernization Act is a straightforward 
bill that improves Medicare's mental health benefits as follows:
  It reduces the discriminatory co-payment for outpatient mental health 
services from 50 percent to the 20 percent level charged for most other 
Part B medical services.
  It eliminates the arbitrary 190-day lifetime cap on inpatient 
services in psychiatric hospitals.
  It improves beneficiary access to mental health services by including 
within Medicare a number of community-based residential and intensive 
outpatient mental health services that characterize today's state-of-
the-art clinical practices.
  It further improves access to needed mental health services by 
addressing the shortage of qualified mental health professionals 
serving older and disabled Americans in rural and other medically 
underserved areas by allowing state licensed marriage and family 
therapists and mental health counselors to provide Medicare-covered 
services.
  Similarly, it corrects a legislative oversight that will facilitate 
the provision of mental health services by clinical social workers 
within skilled nursing facilities.
  It requires the Secretary of Health and Human Services to conduct a 
study to examine whether the Medicare criteria to cover therapeutic 
services to beneficiaries with Alzheimer's and related cognitive 
disorders discriminates by being too restrictive.
  In April 2002, President Bush identified unfair treatment limitations 
placed on mental health benefits as a major barrier to mental health 
care and urged Congress to enact legislation that would provide full 
parity in the health insurance coverage of mental and physical 
illnesses. We've made important strides forward for the under-65 
population. Twenty-six states have enacted full mental health parity. 
The Federal Employees Health Benefits Plan (FEHBP) was improved in 2001 
to assure that all federal employees and members of Congress are 
provided parity for mental health and substance abuse treatment. This 
month, Representatives Kennedy and Ramstad intoroduced H.R. 1424, the 
Paul Wellstone Mental Health and Addiction Equity Act, to provide full 
parity for mental health and substance abuse in the private insurance 
market nationwide. I'm proud to join them in support of this 
legislation, which was introduced with 256 cosponsors--well more than 
the 218 majority needed to pass the House of Representatives.
  While some in the business community are concerned about increased 
costs associated with providing these benefits, a recent study of the 
FEHBP mental health coverage concluded that implementation of parity 
benefits led to negligible cost increases. In fact, some businesses are 
now embracing parity because they recognize the increased productivity 
from workers over the long run and how improving access to mental 
health services has the potential to avoid other additional costly 
care.
  I am similarly sure that modernizing the Medicare mental health 
benefit will reduce unnecessary spending. Medicare mental health 
expenses have historically been heavily skewed toward more expensive 
inpatient services, with 56 percent of the total going to inpatient 
care and only 30 percent toward outpatient services in 2001. This 
relationship is in contrast to national trends showing a reversal in 
inpatient and outpatient spending over the past decade. In the last 10 
years, inpatient spending declined from 40 percent to 24 percent, while 
outpatient spending increased from 36 percent to 50 percent of all 
mental health spending. In addition, improving beneficiary access to 
timely mental health care could well yield savings by minimizing the 
need for other services.

  Science has demonstrated that mental illness and substance abuse are 
manifestations of biological diseases. It is long past time for

[[Page E633]]

us to take action with regard to Medicare's inadequate mental health 
benefits and structure. Over the years, Congress has updated Medicare's 
benefits for treatment of physical illnesses as the practice of 
medicine has changed. The mental health field has undergone many 
advances over the past several decades. Effective research-validated 
interventions have been developed for many mental conditions that 
affect stricken beneficiaries. Most mental conditions no longer require 
long-term hospitalizations, and can be effectively treated in less 
restrictive community settings. This bill recognizes these advances in 
clinical treatment practices and adjusts Medicare's mental health 
coverage to account for them.
  The Medicare Mental Health Modernization Act removes discriminatory 
features from the Medicare mental health benefits while facilitating 
access to up-to-date and affordable mental health services for our 
senior citizens and people with disabilities. I urge my colleagues to 
join Mr. Ramstad, Mr. Kennedy, and myself in support of this important 
legislation and to work with us to improve mental health coverage for 
everyone.

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