Arbitrary and Medically Irresponsible: The 190-Day Limit

Mark J. Covall
President and CEO, National Association of Psychiatric Health Systems

Medicare denies specialty inpatient care for mental illness but not any other medical condition.

stockvault-stop-sign103079Over the past few years, we’ve made great strides in eliminating barriers to mental health treatment. In 2008, Congress passed the Mental Health Parity and Addiction Equity Act, which requires private insurers to cover mental health and addiction treatment at the same level as other medical disorders.

However, lawful discrimination against mental illnesses still exists for seniors and disabled adults who receive benefits through Medicare.

That’s because Medicare beneficiaries have a lifetime limit of 190 days of inpatient psychiatric hospital care. There is no such lifetime limit for any other Medicare specialty inpatient hospital service.

How the Lifetime Limit Discriminates
The vast majority of people with mental illnesses don’t require hospitalization. Yet for those with relapsing, long-term mental illnesses and anyone suffering an acute episode, the intensive treatment available at a psychiatric hospital can be life-saving.

Psychiatric hospitals are specialized treatment centers that only provide care for people with mental health conditions. There are 467 non-federal psychiatric hospitals in the United States. These facilities include a mix of state mental health hospitals and private, community psychiatric hospitals.

The 190-day lifetime limit applies only to these specialized psychiatric hospitals (not psychiatric units in general hospitals). Stays in a dedicated psychiatric hospital are sometimes necessary to stabilize symptoms, and younger patients may require repeat stays in order to adjust medication and manage new symptoms.

To cap the number of inpatient days at 190 is both arbitrary and medically irresponsible.

Who Suffers
All Medicare patients are subject to the cap on care and services, but younger beneficiaries are particularly vulnerable to the effects of the discriminatory 190-day limit. The majority (65 percent) of Medicare beneficiaries treated in inpatient psychiatric hospitals qualify for Medicare because of disability. Overall, Medicare patients treated in inpatient psychiatric facilities tend to be younger and poorer than the typical Medicare beneficiary, with nearly one-third of patients younger than age 45.

What’s more, the majority (70 percent) of Medicare patients with more than one admission in a year are younger than 65. Many of these patients are people who were diagnosed with serious chronic mental illnesses, such as schizophrenia or bipolar disorder, at a young age. They will require ongoing treatment over their lifetimes, and so are likely to reach the 190-day limit long before their needs are fully met.

Why It Matters
No matter a patient’s age, releasing him or her before symptoms are stabilized can have serious consequences for both the individual and society at large. Without access to appropriate inpatient care, people with serious mental illness may be left only with such options as ill-equipped outpatient centers, overburdened emergency departments, or (more tragically) homelessness and criminalization.

It’s sobering to think of what might happen to a generation of aging baby boomers who may soon be bumping up against their lifetime limit. And it’s disheartening to realize how our health care system turns it back on some of our most vulnerable citizens. It is long past due to bring the Medicare program up to the standard of all other insurance plans and to—once and for all—eliminate the Medicare 190-day lifetime limit.

As former Sen. John Kerry (D-MA) has said on the Senate floor in past years:

“It’s time to end this outmoded law and ensure that beneficiaries with mental illnesses have access to a range of appropriate settings for their care.”

What You Can Do
It’s anticipated that legislation will be introduced in 2013 to eliminate the Medicare 190-day lifetime limit. The need for proposed legislation has broad support within the mental health community and is backed by 80 national organizations representing hospital associations, seniors’ organizations, disability organizations, and the mental health community, including my own, the National Association of Psychiatric Health Systems (NAPHS).

If you are living with mental illness, have a loved one facing this discriminatory reality, or if you simply believe people with mental illness deserve fair access, you can take action to abolish the lifetime limit.

Visit the NAPHS website to learn more about Congressional action under consideration. From our site, you can also send an email (already composed and requiring only your name) directly to your Senators and House Representative urging them to abolish the 190-day limit.

Your Turn
Have you experienced an imbalance in coverage for mental health conditions compared to other medical conditions? Comment below to let us know!

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  1. […] Tuesday’s Expert Perspective, Mark Covall discussed Medicare’s 190-day limit for inpatient care for mental illness. Today, we offer a bit of background on this […]