Medicare Limits Mental Health Services | New


According to Lynn Cooper, behavioral health specialist for the Pennsylvania Association of Area Agencies on Aging, one of Medicare’s biggest problems is seniors’ limited access to mental health services.

Cooper said Medicare only allows psychologists, psychiatrists, licensed clinical social workers and nurse practitioners to provide therapy to older adults. The Centers for Medicare & Medicaid Services has released a 2023 Physician Fee Schedule (PFS) Proposed Rule that announces and seeks public comment on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS). physicians (PFS) and other Medicare Part B payment policy issues.

“It’s not enough, and it’s impossible to find psychiatric time, to find licensed psychologists and clinical social workers,” Cooper said. “This proposed new regulation will open it up to allow marriage and family therapists and other mental health professionals to bill Medicare. If we can get this across, it will help our mental health providers a lot. »

Proposals include modernizing behavioral health service coverage and improving access and quality by allowing licensed professional counselors, marriage and family therapists and other types of practitioners to bill Medicare under supervision. general; allow psychiatric diagnostic assessments to serve as the initial visit for behavioral health integration and pay for licensed clinical psychologists and clinical social workers providing integrated behavioral health services as part of a patient’s primary care team ; consolidation of certain chronic pain management and treatment services into new monthly payments; and covering mobile unit processing and recovery services, Cooper said.

Cooper, who is in therapy for depression, said she lost her counselor on her 65th birthday. Her counselor could not bill Medicare because that specific coverage does not cover a licensed master’s-level marriage and family therapist.

“These new regulations would allow him to do that,” she said. “I was able to find a new therapist, but it took me six months on a waiting list. The only reason they accepted me is because I have supplemental health insurance. If I only had Medicare, they wouldn’t accept me. The rate is so horribly low that it doesn’t even cover their cost.

Jessica Cohick, the local PA MEDI coordinator for the Northumberland County Agency on Aging, said she helps Medicare beneficiaries find insurance and access benefits, such as PACE/PACEnet, Extra Help, the Medicare savings program and in some cases even Medicaid. . The program is free and can provide all Medicare beneficiaries, regardless of age, with insurance advice to help them choose the insurance that best suits their needs.

Traditional health insurance covers mental health care services for conditions such as depression and anxiety, such as counseling or psychotherapy, Cohick said.

“Coverage includes services that are typically provided in an outpatient setting such as a doctor’s office or hospital outpatient department,” Cohick said. “These services may include visits to a psychiatrist or other physician, clinical psychologist, clinical nurse specialist, clinical social worker, nurse practitioner or physician assistant. Covered mental health care includes partial hospitalization services, which are intensive outpatient mental health services provided during the day. Partial hospitalization services are provided by a hospital to its outpatients or by a community mental health centre.

Typically, Cohick said, the beneficiary will pay 20% of the Medicare-approved amount, and the Part B deductible applies to mental health care services.

“While this is how traditional Medicare works, beneficiaries can purchase other insurance to help with health care coverage, such as Medicare Supplements (Medigap) or Medicare Advantage plans. In the case of a Medigap policy, Medicare rules will apply,” she said. “However, if a beneficiary chooses to enroll in an Advantage plan, the beneficiary will be subject to the guidelines of that plan.”

As with all insurance, enrollees must do certain things to access services, Cohick said.

“The type of secondary insurance a beneficiary chooses can affect the ease with which services are provided,” Cohick said. “Whether a beneficiary is enrolled in traditional Medicare or a Medigap plan, the beneficiary can be seen wherever Medicare is accepted. There might be deductibles and coinsurance, depending on the Medigap plan they have, but as mentioned, as long as that provider accepts Medicare, they will be able to book appointments. If a beneficiary has chosen an Advantage plan, usually a PPO or HMO, they will need to find a provider that accepts their plan and pay the copayments due according to the plan’s rules.

Some of the challenges that exist with regard to older people’s access to mental health services would be transportation, which is an ongoing issue for many Valley residents as well as providers who do not accept certain insurances, a said Cohick.

Karen Leonovich, administrator of the Northumberland County Agency on Aging, said Cohick was a “third party with no opinion”.

“You can go to a local insurance company and they’ll tell you about the same issues, but they tend to sell you their specific plan,” Leonovich said. “Jess will review all plans and has no bias towards any of them. She is there to provide information and make changes if you are interested.


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