[Congressional Record Volume 167, Number 187 (Monday, October 25, 2021)]
[Senate]
[Pages S7340-S7341]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Ms. COLLINS (for herself and Ms. Smith):
S. 3061. 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 with my colleague, Senator
Tina Smith, 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. Given the steps
that Congress has already taken to establish parity and improve
coverage of mental health services, this change is long overdue,
particularly as the COVID-19 pandemic has worsened the already alarming
trends in the mental health of some Americans.
Notably, an estimated 13.1 million adults aged 18 or older in the
United States are living with serious mental illness, representing 5.2
percent of all adults nationwide. These illnesses, such as
schizophrenia and bipolar disorder, are chronic conditions that require
ongoing treatment and care over a lifetime. When left untreated, they
can be some of the most debilitating and destructive illnesses
afflicting Americans.
Unfortunately, our current mental health system is fragmented, and
these individuals all too often lack access to the care that they need.
That is why I have worked to improve mental health services across the
lifespan and break down barriers to treatment. The legislation I am
introducing today eliminates another barrier in Medicare, the 190-day
lifetime cap on inpatient services in psychiatric hospitals.
Most Medicare beneficiaries treated in inpatient psychiatric
facilities qualify because of a disability. As such, this current
restriction disproportionately impacts non-elderly Medicare
beneficiaries--mainly those living with schizophrenia and bipolar
disorder who may be diagnosed at a younger age and stay on Medicare
longer as a result. Sadly, it is young adults aged 18 to 25 years who
currently have the highest prevalence of serious mental illness of any
age group.
Furthermore, 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. While 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, 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.
During their life, people with serious mental illnesses may need
repeated psychiatric inpatient hospital stays to manage their condition
and regain quality of life in their community of choice. The 190-day
lifetime limit can hurt people by arbitrarily ending coverage and can
disrupt care from a provider who is most familiar with the patient.
Moreover, when individuals with mental illness cannot receive care in
the right setting, they often end up in hospital emergency rooms, in
jails, or on the streets--leading to worse long-term outcomes for the
individual, more pain and suffering for family members, and a greater
cost to the taxpayer.
Outside a psychiatric inpatient hospital, it is difficult for many
healthcare facilities to meet the treatment needs of those suffering
with severe mental illness. Many general hospitals lack psychiatric
care capacity, and there are countless examples of psychiatric boarding
in emergency departments. Skilled nursing facilities may also 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, or not at all, if they are on the streets or
are on long waitlists for care. As one local sheriff in Aroostook
County recently told me, ``Law enforcement is not equipped to handle
individuals with mental health challenges and yet we are faced with
that reality every day.'' Similarly, a behavioral health provider in
Presque Isle, ME, said, ``Imposing a limit may appear to reduce cost;
however, the true cost-and toll-on community resources is far greater
than any savings incurred by Medicare.''
On top of all of these existing challenges, it is clear the COVID-19
pandemic has increased stress and isolation, disrupted care services,
and dramatically changed everyday life and even living environments for
many Americans. With research pointing to greater psychological
distress during the pandemic for people with mental illnesses, already
a particularly vulnerable population, I fear we will be trying to make
up for lost strides in behavioral health care for years to come. Now
more than ever, we must work on commonsense reforms that provide parity
between behavioral and physical health care, as well as strive to
increase access to support and improve care coordination.
As the American Hospital Association, which endorses this bill, said,
``As we work to further integrate physical and behavioral health to
better address the nation's behavioral health needs, one major obstacle
to parity remains in the Medicare program--the 190-day lifetime limit
on coverage for certain inpatient psychiatric treatment. With the
nation's population aging and an increasing number of seniors and
people with disabilities seeking inpatient care to address their
behavioral health needs, now is the time to repeal this discriminatory
policy and ensure that Medicare beneficiaries can receive necessary
inpatient psychiatric care.''
The pandemic may have had a disastrous effect on the mental health of
the Nation, but it has also led to more visibility and the
understanding that individuals with serious mental illness, their
families, and the communities in which they live do not have access to
the care and resources they need. I hope we can use what we have
learned throughout the pandemic as an opportunity to reduce stigma and
make overdue reforms like removing the 190-day lifetime cap on
inpatient services in psychiatric hospitals.
Our legislation, the Medicare Mental Health Inpatient Equity Act, is
supported by a wide range of organizations, including the American
Hospital Association and the Mental Health Liaison Group, a coalition
of 57 national organizations representing consumers, family members,
and mental health and addiction providers. This includes support from
the National Association of Behavioral Healthcare, the American
Psychiatric Association, the American Psychological Association, the
National Alliance on Mental Illness, and Mental Health America.
I urge my colleagues to support this important critical legislation
to bring greater mental health parity to the Medicare Program and give
those suffering with serious mental illness access to the care they so
desperately need.
Mr. President, I ask unanimous consent that the material be printed
in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
American Hospital Association,
Washington, DC, October 20, 2021.
Hon. Susan M. Collins,
Senate,
Washington, DC.
Hon. Tina Smith,
Senate,
Washington, DC.
Dear Senator Collins and Senator Smith: On behalf of our
nearly 5,000 member hospitals, health systems and other
health care organizations, our clinician partners--including
more than 270,000 affiliated physicians, 2 million nurses and
other caregivers--and the 43,000 health care leaders who
belong to our professional membership groups, the American
Hospital Association (AHA) is pleased to support your
legislation, the Medicare Mental Health Inpatient Equity Act.
On the front lines of the COVID-19 pandemic, America's
hospitals and health systems witness firsthand its far-
reaching effects on behavioral health. The stress from
unemployment or underemployment, isolation due to quarantine
or COVID-19 restrictions, and grief over loved ones lost to
the pandemic are possible to manifest in increases in already
high rates of deaths from suicides and substance use
disorder. Beyond COVID-19, we know that as a country to
prioritize resources that support the behavioral health needs
of the country. These investments will not only help to
stymie the wave of unmet demand for behavioral health
services that has been exacerbated by the COVID-19 pandemic,
but also improve America's overall health.
[[Page S7341]]
As we work to further integrate physical and behavioral
health to better address the nation's behavioral health
needs, one major obstacle to parity remains in the Medicare
program--the 190-day lifetime limit on coverage for certain
inpatient psychiatric treatment. With the nation's population
aging and an increasing number of seniors and people with
disabilities seeking inpatient care to address their
behavioral health needs, now is the time to repeal this
discriminatory policy and ensure that Medicare beneficiaries
can receive necessary inpatient psychiatric care.
We are grateful for your leadership on this issue and
stand ready to work with you to enact this important
legislation.
Sincerely,
Stacey Hughes,
Executive Vice President.
____
Mental Health Liaison Group,
Washington, DC, October 18, 2021.
Hon. Susan Collins,
Senate,
Washington, DC.
Hon. Tina Smith,
Senate,
Washington, DC.
Dear Senators Collins and Smith: The Mental Health Liaison
Group (MHLG)--a coalition of national organizations
representing consumers, family members, mental health and
addiction providers, advocates and other stakeholders
committed to strengthening Americans' access to mental health
and addiction care--is writing to express our strong support
for the Medicare Mental Health Inpatient Equity Act. This
critical legislation eliminates the discrimination against
mental illnesses that continues to exist in the Medicare
program as Medicare beneficiaries are limited to 190 days of
inpatient psychiatric hospital care during their lifetime.
This lifetime limit does not apply to psychiatric units in
general hospitals and there is no such lifetime limit for any
other Medicare specialty inpatient hospital service.
Through passage of landmark legislation, the Paul
Wellstone and Pete Domenici Mental Health Parity and
Addiction Equity Act of 2008, Congress put coverage for
mental health and substance use disorders on par with other
medical disorders. Also, that year, Congress enacted
legislation to equalize the Medicare outpatient coinsurance
for mental and physical health. Despite this progress,
discrimination against Medicare patients with mental health
disorders who require ongoing psychiatric treatment and
hospitalizations, when in crisis, continues to exist.
The Medicare Payment Advisory Commission reported that
most Medicare beneficiaries treated in inpatient psychiatric
facilities qualify for Medicare because of disability, hence
they tend to be younger and poorer that the typical Medicare
beneficiary. These Medicare beneficiaries live with serious
mental illnesses (such as schizophrenia and bipolar disorder)
and who are living with these disorders from a relatively
young age. These illnesses are chronic and will require
ongoing treatment and care over their lifetimes, including
hospitalization when in crisis.
The elimination of the 190-day limit will equalize
Medicare mental health coverage with private health insurance
coverage, increase access for the most seriously ill, improve
continuity of care and create a more cost-effective Medicare
program.
The MHLG applauds your bipartisan leadership and looks
forward to working with you and your staff to enact this
important legislation.
Sincerely,
2020 Mom; American Art Therapy Association; American
Association for Marriage and Family Therapy; American
Association for Psychoanalysis in Clinical Social Work;
American Association of Child & Adolescent Psychiatry;
American Association of Suicidology; American Association on
Health and Disability; American Counseling Association;
American Dance Therapy Association; American Foundation for
Suicide Prevention; American Group Psychotherapy Association;
American Mental Health Counselors Association; American
Nurses Association; American Psychiatric Association;
American Psychoanalytic Association; American Psychological
Association; American Society of Addiction Medicine; Anxiety
and Depression Association of America; Association for
Ambulatory Behavioral Healthcare; Association for Behavioral
and Cognitive Therapies.
Centerstone; Children and Adults with Attention-Deficit
Hyperactivity Disorder; Clinical Social Work Association;
Confederation of Independent Psychoanalytic Societies;
Depression and Bipolar Support Alliance; Eating Disorders
Coalition; Global Alliance for Behavioral Health and Social
Justice; International Certification & Reciprocity
Consortium; International OCD Foundation; International
Society for Psychiatric Mental Health Nurses; The Kennedy
Forum; Maternal Mental Health Leadership Alliance; Mental
Health America; NAADAC, the Association for Addiction
Professionals; National Alliance on Mental Illness; National
Alliance to Advance Adolescent Health; National Association
for Behavioral Healthcare; National Association for
Children's Behavioral Health.
National Association for Rural Mental Health; National
Association of County Behavioral Health and Developmental
Disability Directors; National Association of Pediatric Nurse
Practitioners; National Association of Social Workers;
National Association of State Alcohol and Drug Abuse
Directors (NASADAD); National Association of State Mental
Health Program Directors; National Board for Certified
Counselors; National Council for Mental Wellbeing; National
Disability Rights Network; National Federation of Families;
National League for Nurses; National Register of Health
Service Psychologists; NHMH--No Health without Mental Health;
Psychotherapy Action Network; Residential Eating Disorders
Consortium; Schizophrenia & Psychosis Action Alliance;
Treatment Communities of America; Vibrant Emotional Health;
Well Being Trust.
____________________