[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.

                          ____________________