NYAPRS Note: The article below highlights the complex issue of mental health treatment shortages for Medicare recipients, despite new parity regulations mandating that insurance companies offer equivalent behavioral health treatment to physical health treatment. One aspect is the administrative burden of contracting and payments through Medicare and its various managed care arrangements, as well as a perceived (but debated) lower payment for services. However, the issue goes much deeper. Geriatric mental health is not an attractive profession overall, and not a specialty offered in all degree or licensure programs. And, as is noted below, many mental health practitioners who see widely diverse communities of people are often ill equipped to serve elderly persons and/or persons with complex needs. A broad range of interventions are necessary, and include state regulation of insurance plans to ensure that network adequacy reflects real contracts, provider directories are participant-focused, and that health plans offering Medicare coverage form mutually beneficial relationships with providers.
Medicare Requires Mental Health Parity; Provider Shortage Remains
CaliforniaHealthline; 1/2/2014
As of Jan. 1, Medicare is required to pay the same amount for mental health care treatment as it does for most medical services, the New York Times‘ “The New Old Age” reports.
Background
Under the 2008 Medicare Improvements for Patients and Providers Act, Medicare was required to cover an increasingly larger portion of the cost of outpatient mental health services beginning in 2010. In 2008, Medicare covered 50% of the cost of such treatment, which increased to 65% last year.
Details of Parity Requirement
Beginning Jan. 1, Medicare is required to pay 80% of the cost of mental health services, bringing coverage for those services in line with most medical services.
Andrea Callow, a policy lawyer at the Center for Medicare Advocacy, said, “Hopefully, older adults who previously were unable to afford to see a therapist will now be more likely to do so.”
Provider Shortage Remains
However, some experts note that the move toward parity does little to address the shortage of mental health professionals who are trained to work with elderly U.S. residents.
Gary Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in New York City, said, “There are a lot of mental health providers out there, but very few have training to work with older adults.”
According to “The New Old Age,” providers have little incentive to treat elderly patients because Medicare reimbursement rates are low compared with private insurers (Graham, “The New Old Age,”New York Times, 12/27/13).
Study Finds Many Psychiatrists Do Not Accept Insurance
In related news, a study published in the Journal of the American Medical Association found that only about half of psychiatrists accept health insurance, meaning millions of individuals who gain access to mental health care coverage under the Affordable Care Act might still have to pay out of pocket or go without care, USA Today reports.
For the study, researchers at Cornell Medical College examined data from the National Center for Health Statistics.
Tara Bishop, lead author and associate professor of public health and medicine at Cornell Medical College, said the study showed 53% of psychiatrists accepted insurance between 2009 and 2010, compared with 89% of all other physicians.
She noted that her team detected similar trends in Medicare, with 54.8% of psychiatrists accepting Medicare, compared with 86% of other physicians.
Bishop attributed the difference to psychiatrists receiving lower reimbursement rates than other physicians, a decrease in medical students studying psychiatry and the administrative burden of dealing with insurers.
Although the ACA requires insurers to offer equal coverage for both physical and mental health care, Bishop noted that it does not require psychiatrists to accept the coverage. She said, “I think it’s going to take multiple stakeholders and minds to address the crisis of access to mental health care in this country” (Kennedy, USA Today, 12/29/13).
http://www.californiahealthline.org/articles/2014/1/2/medicare-requires-mental-health-parity-provider-shortage-remains