Pascrell, Chu, Smith Introduce Laws to Expand Medicare Outpatient Mental Services 


Pascrell, Chu, Smith Introduce Laws to Expand Medicare Outpatient Mental Services 

Gap in coverage denies help to thousands and thousands with mental illness


WASHINGTON, DC – U.S. Reps. Bill Pascrell, Jr. (D-NJ-09), Judy Chu (D-CA-27), and Adrian Smith (R-NE-03), members of the tax-writing House Ways and Means Committee, have introduced H.R. 8878, laws to expand Medicare mental health coverage by making a latest profit category for intensive outpatient programs (IOPs).


“Providing complete health care demands not only coverage for physical health, but mental health too,” said Rep. Pascrell. “Amongst Medicare beneficiaries, around one in every 4 – a full quarter – have a mental health issue. Yet, these Americans often fall through a niche in care because Medicare only offers coverage for essentially the most and least restrictive settings for mental health and substance use disorder. This watershed laws will fix that gap by finally making a profit category for intensive outpatient services. This transformation will help the health coverage and mental well-being of thousands and thousands of Americans. It’s long overdue.”


“As a psychologist, I’m committed to improving the mental health care available to Americans, including those within the Medicare program. For too long, Medicare has covered only the intense ends of the care spectrum relating to mental health and substance use disorders,” said Rep. Chu. “But we all know that mental health care, like all health care, requires various levels of care depending on the severity of the disease and what’s best for the patient. Our bill will close that gap, and offer intensive outpatient services to Medicare beneficiaries who don’t require around the clock care, but who need more robust treatment than a periodic office visit. I’m proud to introduce this bipartisan laws with my Ways and Means colleagues Representatives Pascrell and Smith, and I look ahead to working with them to enhance take care of Medicare beneficiaries across the country.


“As mental health care has trended away from psychiatric hospitals toward community-based outpatient care, many rural areas have lost access to care options in each settings,” said Rep. Smith. “While advancements in medical knowledge and technology have allowed more mental health care services to be delivered in outpatient settings, including some intensive care, Medicare coverage has not at all times kept pace. This bipartisan bill brings latest flexibilities in coverage to match how care is being delivered and represents a step forward in Medicare modernization, completing the spectrum of mental health care options to permit resources to be more effectively utilized. Most significantly, this bill will help provide seniors increased access to the care they need. I thank my colleagues on either side of the aisle for working with me on this essential laws.”


Intensive outpatient programs discuss with outpatient services designed to treat individuals with mental health and substance use disorders that don’t require inpatient or residential services, resembling medical detoxing or 24-hour supervision. Such individuals require more intensive treatment than available in a typical outpatient setting.


While the particular services can vary depending on the precise setting, diagnosis, and the severity of conditions, IOP services generally include a specified variety of hours of structured treatment each week consisting of individual or group therapy, medication management, and psychoeducation.


Currently, the Medicare program doesn’t cover IOP as a profit category. Although similar services are covered under the present partial hospitalization program (PHP) if delivered by hospitals and community mental health centers, Medicare requires that a physician determine a person need at the very least 20 hours per week of outpatient mental health services and be inpatient-eligible to receive PHP coverage. Consequently, many beneficiaries who need intensive outpatient services but whose conditions usually are not severe enough to require 20 hours per week of care or otherwise wouldn’t be inpatient eligible cannot access the care they need and fall through the cracks.


This laws will expand Part B to incorporate IOP as a covered profit, allowing outpatient hospitals, community mental health centers, rural health centers, federally qualified health centers, and opioid treatment programs to deliver intensive outpatient services to eligible beneficiaries through a per diem payment. Whereas the PHP profit requires a person to want a minimum of 20 hours per week of care, this policy requires a person to only need nine hours per week of care to be eligible for the IOP profit; it also doesn’t require the person to be eligible for inpatient care.




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