[Congressional Record Volume 166, Number 102 (Tuesday, June 2, 2020)]
[Senate]
[Pages S2650-S2651]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTION

      By Ms. COLLINS (for herself and Ms. Smith):
  S. 3864. A bill to amend title XVIII of the Social Security Act to 
eliminate the 190-day lifetime limit on inpatient psychiatric hospital 
services under the Medicare Program; to the Committee on Finance.
  Ms. COLLINS. Mr. President, I rise today to introduce the Medicare 
Mental Health Inpatient Equity Act, legislation that eliminates 
Medicare's arbitrary 190-day lifetime cap on inpatient services in 
psychiatric hospitals. This change is long overdue given the steps that 
Congress has taken to improve coverage of mental health services. I am 
pleased to be joined by Senator Tina Smith (D-MN), who has been a 
champion for greater access to mental health care.
  Left untreated, mental illnesses are some of the most disabling and 
destructive illnesses afflicting Americans. Unfortunately, our current 
mental health system is fragmented, and family members with serious 
mental illness all too often lack access to the care that they need. 
That is why I have worked consistently and vigorously to improve mental 
health services across the lifespan.
  I was an original cosponsor of the Senator Paul Wellstone Mental 
Health Parity Act, a landmark law that generally prevents group health 
plans and health insurance issuers that provide mental health or 
substance use disorder benefits from imposing less favorable benefit 
limitations on those benefits than on medical and surgical benefits. I 
was a longtime supporter of the Excellence in Mental Health Act, which 
increased Americans' access to community mental health and substance 
use treatment services through the Certified Community Behavioral 
Health Clinic (CCBHC). I have also worked with my colleagues Senator 
Durbin and Senator Portman to support greater residential treatment 
options by modifying Medicaid's restrictive Institute of Mental Disease 
exclusion as part of the Substance Use-Disorder Prevention that 
Promotes Opioid Recovery and Treatment for Patients and Communities Act 
(the ``SUPPORT Act'').
  As chairman of the Aging Committee, I also recognize that seniors 
have significant unmet mental health

[[Page S2651]]

needs and that their Medicare coverage can be greatly improved. I was 
an original cosponsor of the Medicare Mental Health Copayment Equity 
Act, which was signed into law in 2008, that eliminated higher 
outpatient copayments for mental health services I have also recently 
re-introduced legislation with Senator Brown that would update the 
Medicare program by recognizing clinical psychologists as independent 
care providers, thus expanding mental health care options and access 
for Medicare beneficiaries.
  The legislation I am introducing today breaks down another barrier in 
Medicare, the 190-day lifetime cap on inpatient services in psychiatric 
hospitals. No other Medicare inpatient service has these types of 
arbitrary caps, which is why elimination of Medicare's lifetime cap was 
a recommendation of the 2016 White House Mental Health and Substance 
Use Disorder Parity Task Force.
  I recognize that this cap was originally intended to limit the 
federal government's role in paying for long-term custodial support of 
the mentally ill. And no one wants to go back to the abusive days of 
long term institutionalization, which is why l have championed so many 
measures to help bolster community mental health resources. At the same 
time, keeping a cap on inpatient days at psychiatric hospitals--
particularly for patients who have been living with serious mental 
illness from a young age--undermines patient treatment options and can 
lead to disruptive transitions of care. Many general hospitals lack 
psychiatric capacity and there are countless examples across the 
country of psychiatric boarding in emergency departments. Skilled 
nursing facilities may not be best suited to provide the complex and 
specialized psychiatric care these beneficiaries need. Finally, too 
many patients find themselves receiving care in prisons.
  According to a 2019 Mathematica report commissioned by the Department 
of Health and Human Services, most fee-for-service Medicare 
beneficiaries who use inpatient psychiatric facilities have primary 
diagnoses of schizophrenia, major depressive disorder, and bipolar 
disorder, but Alzheimer's and related diagnoses are also common. We 
need to help patients with serious mental illness recover regardless of 
the setting where they are receiving care. The Medicare Mental Health 
Inpatient Equity Act is supported by a wide range of mental health 
groups, including the National Association of Behavioral Healthcare, 
the American Psychiatric Association, the American Psychological 
Association, and Mental Health America.
  I urge my colleagues to support this legislation.

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