[Congressional Record (Bound Edition), Volume 149 (2003), Part 5]
[Extensions of Remarks]
[Page 6526]
[From the U.S. Government Publishing Office, www.gpo.gov]




  INTRODUCTION OF THE MEDICARE MENTAL HEALTH MODERNIZATION ACT OF 2003

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Tuesday, March 18, 2003

  Mr. STARK. Mr. Speaker, I rise with a group of colleagues to 
introduce the Medicare Mental Health Modernization Act of 2003. 
Medicare's mental health coverage is woefully inadequate. Instead of 
the standard 20 percent coinsurance payment required by beneficiaries, 
mental health services require a 50 percent co-payment, limited 
community-based treatments are covered, and there is a cap on mental 
health hospitalization days. The bill we are introducing today 
eliminates this blatant mental health discrimination from Medicare and 
modernizes the Medicare mental health benefit to meet today's standards 
of care.
  In the past, the late Senator Paul Wellstone championed this effort 
in the U.S. Senate. This year, Senator Jon Corzine has stepped forward 
to introduce the companion legislation in the Senate. I want to thank 
Senator Corzine for his commendable efforts on behalf of this important 
legislation.
  One in five members of our senior population display mental 
difficulties that are not part of the normal aging process. In primary 
care settings, over a third of senior citizens demonstrate symptoms of 
depression and impaired social functioning. Older adults also have the 
highest rate of suicide of any segment of our population. Furthermore, 
mental illness is the single largest diagnostic category for Medicare 
beneficiaries on disability. There is a critical need for effective and 
accessible mental health care for the Medicare population. 
Unfortunately, the current structure of Medicare mental health benefits 
is inadequate and presents multiple barriers to treatment access. 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 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. The mental health field has undergone many 
advances over the past several decades. Effective, research-validated 
interventions have been developed for many of these 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.
  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.
  The push for mental health parity is ongoing. We've made important 
strides forward for the under-65 population. Twenty-three states have 
already enacted full mental health parity and the Federal Employees 
Health Benefits Plan was improved in 2001 to assure that all federal 
employees are provided mental health parity. Last April, President Bush 
called for Congress to enact legislation to provide equivalence for 
private sector health insurance coverage of mental and physical 
conditions (though he has yet to endorse any legislation to achieve 
that goal). This year, legislation to enact real mental health parity 
for those with private health insurance already has the bipartisan 
support of 180 members in the House and 43 U.S. Senators. I fully 
support these efforts as well.
  What has been too-often missing from this overall mental health 
parity debate is the fact that the Medicare program continues to fail 
to meet the mental health needs of America's seniors and those with 
disabilities. That's why we've introduced the Medicare Mental Health 
Modernization Act. That's also why this bill has received support from 
numerous mental health advocacy and provider organizations including: 
the National Mental Health Association, the American Association of 
Geriatric Psychiatry, the American Association of Marriage and Family 
Therapists, the American Counseling Association, the American Mental 
Health Counselors Association, the American Psychological Association, 
the National Association of County Mental Health Directors and the 
National Association of Social Workers.
  When Medicare was created in 1965, mental health treatment was very 
different than it is today. Over the years, Congress has updated 
Medicare's benefits as the practice of medicine has changed. It is past 
time for us to take this action with regard to Medicare's currently 
inadequate mental health benefits. The Medicare Mental Health 
Modernization Act of 2003 removes discriminatory features from the 
Medicare mental health benefits and helps facilitate access to up-to-
date and affordable mental health services for our elderly and 
disabled. I encourage my colleagues to support its passage into law.

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