By former U.S. Rep. Patrick J. Kennedy

Fatal drug overdoses rose 30% in 2020, reaching a record high of 93,331, according to the Centers for Disease Control and Prevention (CDC). Alcohol use is up. The percentage of adults experiencing symptoms of anxiety and/or depression increased significantly since March 2020. The true impact of the COVID-19 pandemic has yet to fully unfold. One has to question why then, amid copious red flags, mental health and addiction coverage would have been excluded from recent proposed fixes to Medicare—a federal insurance program that serves over 62 million Americans over 65, younger disabled people, and dialysis patients. Adding Medicare coverage for hearing, vision, and dental, as Congressional leaders have proposed, is a massive step forward in improving health equity in our country. However, we can’t ignore our leaders’ failure to rectify (existing) major issues with mental health and addiction treatment coverage under Medicare.      

Accordingly, this week, The Kennedy forum led a letter joined by leaders in the mental health and addiction advocacy field, urging Senate Majority Leader Chuck Schumer and House Speaker Nancy Pelosi to address those issues by extending the Mental Health Parity and Addiction Equity Act of 2008 to Medicare and making changes to the Social Security Act to end Medicare’s longstanding discrimination against individuals with mental health and substance use disorders (MH/SUDs). Read it here.

Below is a list of items that must be addressed:

• Not Subject to the Federal Parity Act. Discriminatory coverage for MH/SUD treatment within Medicare is legal, including for Medicare Advantage plans.
• 190-Day Lifetime Limit on Inpatient Psychiatric Hospital Services. No other medical condition has this limitation, which arbitrarily cuts off necessary treatment for individuals with serious mental illness.
• Narrow Range of Covered Providers and Limitations on Practice. Services from licensed mental health counselors, marriage and family therapists, and peer support specialists are not reimbursable under Medicare—and other mental health professionals face barriers—resulting in further limitations on access to MH/SUD care.
• Lacks Coverage of Intensive, Evidence-Based Interventions. Medicare does not cover evidence-based, multi-disciplinary team interventions for people with the most severe MH/SUDs. This includes Coordinated Specialty Care for early psychosis, Assertive Community Treatment (ACT) teams, and medical nutrition therapy for eating disorders.
• Limited Coverage of Levels of Behavioral Health Care. Medicare does not cover residential care or intensive outpatient services for MH/SUD. It also inadequately covers services within each of the American Society of Addiction Medicine (ASAM) Criteria’s five broad levels of substance use disorder care.
• No Coverage for Freestanding Community-Based SUD Treatment Facilities. Medicare does not authorize payment for treatment in these facilities, which needlessly limits the availability of SUD treatment.
• Restrictions on Telehealth. Medicare’s coverage of telehealth services is very limited, though some temporary flexibilities have been granted during the COVID-19 pandemic.

If you would like to join us in calling for better MH/SUD treatment coverage in Medicare, please contact your Congressional representatives and ask them to extend parity protections to Medicare and end discrimination against Americans with MH/SUDs.