Medicare tagged posts

Ben Nevers
State Senator Louisiana

For the past three weeks we’ve devoted this blog to raising awareness around a proposed regulation by the CMS to restrict access to mental health care. But did you know that individual states have fail first policies as well, through the implementation of their Medicaid programs? Read today’s post to learn if your state is on the list.

Louisiana is a National Leader with their “Prescriber Prevails” Medicaid Policy
Keeps access to medication in the hands of physicians and patients

There are many reasons why people do not receive adequate mental health treatment, each of those reasons is as unique and as highly personalized as the individuals themselves. Yet, nearly all stem from the fundamental problem of access. Access to timely, appropriate, affordable mental health care is too often limited and restricted as a result of the following:

• a shortage of providers or inpatient beds in a given community
• insurer restrictions on what, when and how providers can prescribe medication and treatment
• cost barriers that put mental health care financially out of reach

When such barriers obstruct access to care, more people are at risk for serious, disabling mental illness; and in those cases, society bears the related costs. For that reason, I believe we must work together to address these barriers and expand access to mental health services. The cost of not doing so is enormous.

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Annual enrollment for Medicare ends on December 7, 2013. There has been a lot written about the mental health parity final ruling and the ACA or Obamacare. It is important to note that these new regulations do not apply to Medicare. In order to maximize mental health care seniors, should look carefully at their supplemental policies.

To better help seniors navigate their options, we are reposting excerpts from several relevant posts from the Center for Medicare Advocacy, Inc. (CMA) and providing links to this valuable information.

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Over and over again we hear of tragedies that might have been averted if only people had access to quality mental health care.  The Daily Beast does an excellent job of covering the latest such tragedy involving Gus Deeds stabbing his father, Virginia politician Creigh Deeds.  According to the Richmond Times-Dispatch Gus Deeds did receive a psychiatric evaluation on Monday, the day before the stabbing, but was release due to lack of a psychiatric bed across the entire western Virginia region.

In Tennessee the department of mental health is evaluating their budget for the next several years...

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Christine M. deVries
Chief Executive Officer
American Association for Geriatric Psychiatry

Care for Your Mind is an excellent example of providing needed information to the public on late life mental illness. AAGP applauds the efforts of Care for Your Mind and its efforts on public education as well as encouraging dialogue through polls and other mechanisms on these critical issues.

The results of the recent poll by Care for Your Mind on mood disorders clearly confirms the need for a well-trained health care workforce to take care of the current and future generations of older adults with mood disorders. This same conclusion was reported by the Institute of Medicine (IOM) in their report released last year entitled, The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? The IOM called for immediate action to promote research and incentivize training in geriatric mental health to adequately meet the needs of an elderly population expected to rise above 70 million people by 2030. We know the need is there, but now it is time to take action. It is critical that people contact their policymakers and urge them to eliminate the gaps in services to the elderly with mental illness including mood disorders by increasing access to quality mental health care and addressing the prevalent stigma associated with these diseases. The White House took a first step when they convened a National Conference on Mental Health in June of this year, but there needs to be more. We must now advocate to the US Congress on the need for a well prepared workforce to provide quality care for the older adults with mood disorders. Following are some specific legislative proposals that have been introduced in this session of Congress:

The Care for Your Mind poll enforces the need for health care professionals with specialized training to treat those individuals with mood disorders and other late life mental illnesses. There is a bill that has been introduced into the Senate that would promote teams of health care providers with this expertise to work with primary care providers.

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David Steffens, M.D., M.H.S.
President, American Association for Geriatric Psychiatry

Just as a family with a child suffering from depression, anxiety, or any other illness would want a clinician who specializes in helping children, older adults deserve care from clinicians trained and experienced in diagnosing and treating older patients.

The mental health needs of the elderly differ from the rest of the population.

Why?

In general, older adults have more medical illnesses than younger people and may have cognitive problems that can worsen with depression and other health issues. Older individuals often suffer more losses—such as the loss of a spouse, friends, or independence—and these losses can lead to depression. Older adults may also be reluctant to discuss mental health issues, particularly concerns about memory and Alzheimer’s disease.

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Senator David Carlucci
Chair, Committee on Mental Health and Developmental Disabilities
New York State Senate

On this blog a few days ago, Andrew Sperling of the National Alliance on Mental Illness raised questions about access to mental health treatments under the Affordable Care Act (ACA); and he voiced concerns about people being able to receive the specific mental health drugs they require once the health reform law is implemented.

As Mr. Sperling pointed out, restricting access to a full class of drugs and limiting prescribers’ option to one drug per class—which health plans can opt to do under ACA—can be short-sighted from an economics standpoint and disastrous from a health perspective. Without access to clinically appropriate medication, individuals with mental illness have higher rates of emergency room visits, hospitalization and other health services.

As Chair of the New York State (NYS) Senate Committee on Mental Health and Developmental Disabilities, I understand that in order to manage the health of people living with serious mental illness, patients need guaranteed access to the full range of drugs and services that are most likely to improve their health. Even more important, I recognize that no one understands a patient’s needs better than his or her healthcare provider; and it’s presumptuous—if not irresponsible—to remove decision-making authority from that provider.

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Andrew Sperling, Director of Legislative Advocacy
National Alliance on Mental Illness (NAMI)

The Patient Protection and Affordable Care Act (ACA) offers new choices for quality, reliable, low cost private health insurance and opens Medicaid to more people living with mental illness.

Under the law, all health plans are required to provide certain categories of benefits and services—so-called Essential Health Benefits (EHB). One of these is prescription drugs.

A question mark as to prescription drug coverage
While plans will be required to cover a minimum number of prescription drugs used to treat mental health conditions in a therapeutic class, each plan may choose to cover different medications; and the number of covered drugs will vary by state and by plan.  Most significant, the law does not require plans to cover all drugs in a particular therapeutic class.  As a result, medical and behavioral health plans can avoid covering specific drugs that, in your physician’s judgment, best address your needs.

This poses serious challenges for individuals who are in need of multiple drugs per class, particularly people with serious and persistent mental illness, chronic conditions and disabilities. Antipsychotic medications, for example, are not clinically interchangeable, and providers must be able to select the most appropriate, clinically indicated medication for their patients.  What’s more, physicians may need to change medications over the course of an illness as patients suffer side-effects or their illness is less responsive to a particular drug, and patients requiring multiple medications may need access to alternatives to avoid harmful interactions.

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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.

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