Medicare Mental Health Inpatient Equity Fact Sheet

Background

In 2008, Congress enacted two landmark pieces of legislation designed to eliminate discrimination in health care coverage for mental disorders.  One bill addressed mental health discrimination in the private insurance market, and the other phased out the higher, discriminatory copayment charged by Medicare for outpatient mental health services.

However, there remains a serious mental health inequity in the Medicare system.  Medicare’s beneficiaries are currently limited to only 190 days of care in inpatient psychiatric hospitals.  This lifetime limit directly impacts Medicare beneficiaries’ access to psychiatric hospitals, although it does not apply to psychiatric units in general hospitals.  This arbitrary cap on benefits is discriminatory to those with mental disorders, as there is no such lifetime limit for any other Medicare specialty inpatient hospital service.  The 190-day lifetime limit is problematic for patients being treated in psychiatric hospitals as they may easily exceed the 190 days if they have a chronic mental illness.

In February 2011, Senators John Kerry (D-Massachusetts) and Olympia Snowe (R-Maine) introduced the Medicare Mental Health Inpatient Equity Act, S. 374, which would eliminate the 190-day lifetime limit for services in psychiatric hospitals.  That bill has been referred to the Senate Finance Committee for consideration.  An identical bill, H.R. 2783, was introduced in the House of Representatives in August 2012 by Representatives Paul Tonko (D-New York) and Fortney “Pete” Stark (D-California) and is currently pending before the House Ways and Means Committee.

AAGP Position

AAGP strongly supports non-discriminatory treatment for all Americans with mental disorders and non-discriminatory coverage of mental health services under all types of health benefits programs.  Arbitrary limits on coverage of mental health care should be eliminated wherever they exist.  The remaining statutory discrimination in the Medicare system against persons with mental illnesses must be eliminated, and AAGP will work to achieve enactment of this legislation.

 (March 8, 2012)