In 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 confounding—and life-threatening—limit.
Fear and Politics
Eliminating the 190-day lifetime limit on has been on the stove—albeit not the front burner—for more than two decades.
The limitation originated in the Social Security Act of 1965, when Medicare came into being. In 1965, people feared mental illness; they were biased against psychiatric hospitals and those who received care there. Combined with political strife over whether the states or the federal government should bear the costs of that care, this bias could explain the arbitrary and discriminatory limit.
Despite numerous changes in mental health care administration, medical practice, insurance, and—arguably most important—perceptions and understanding of mental health conditions, the 190-day lifetime limit persists.
And to get rid of it, there needs to be a change to federal law.
Recent Legislation
In 2011, Sen. John Kerry (D-MA) and Rep. Paul Tonko (D-NY) introduced parallel bills to eliminate the 190-day lifetime limit on Medicare coverage of inpatient care at psychiatric hospitals (S. 374 & H.R. 2783, respectively).
The text was simple, essentially eliminating the offending clause (“inpatient psychiatric hospital services furnished to him after such services have been furnished to him for a total of 190 days during his lifetime”) and making grammatical changes accordingly.
Despite being endorsed by a long list of nonprofit mental and behavioral health advocacy, medical professional, education, and support organizations, the bills died in committee.
Who Reaches the Limits
Many of us have experience with recurring and/or treatment-resistant conditions. Hospitalization for up to 30 days is often necessary for a person to become stable, adjust their medication, address co-morbid conditions, and benefit from potentially life-saving interventions.
A person on Medicare who has had six such hospitalizations is on the precipice of exhausting those coverage benefits.
People who suffer from persistent, debilitating mental health conditions deserve appropriate levels of treatment, the likes of which, more often than not, can only be found in a psychiatric hospital.
We must eliminate the 190-day lifetime limit.
What You Can Do
The House Ways and Means Subcommittee on Health recently held a hearing to examine Medicare’s benefit design, with Subcommittee Chair Rep. Kevin Brady (R-TX) noting the need for reforming the Medicare system. If your Representative in Congress sits on the Subcommittee on Health or even on the Ways and Means Committee, you’ve got a direct link to the legislators most involved in this issue. Contact them and tell them why this issue is important to you and that you would like them to work to eliminate the 190-day lifetime limit on Medicare benefits for inpatient psychiatric hospital care.
Mark Covall of the National Association of Psychiatric Health Systems (and author of the Expert Perspective blog on Tuesday) and Michael Fitzpatrick of the National Alliance on Mental Illness submitted testimony (click on “News” tab) about the 190-day lifetime limit. Find out more about the issue from NAPHS and NAMI.
Share your thoughts and experiences with the Care for Your Mind community! Please submit a reply or question below, vote in the 190-day limit poll, or share your personal story.
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