Monday, July 26, 2010

Ask the Expert: Why doesn’t Medicare have to follow the Mental Health Parity Act?

Q.  Why doesn’t Medicare have to follow the Mental Health Parity Act, which mandates that insurance plans cover both physical and mental ailments equally, including maximum limits on hospital stays? 
mileena, California

Medicare will cover office- and clinic-based therapy as well as services you receive in an outpatient hospital program, as long as your provider is one of the following:
• a general practitioner
• a nurse practitioner
• a physicians’ assistant
• a psychiatrist
• a clinical psychologist
• a clinical social worker
• a clinical nurse specialist

Medicare will help pay for the services of non-medical doctors (like psychologists and clinical social workers) only if the providers are Medicare-certified and take assignment, meaning that they accept Medicare’s approved amount as payment in full.

For your initial visit to a mental health professional to determine your diagnosis, and for brief appointments to manage your medications, Medicare pays 80 percent of its approved amount. For other appointments after your initial visit, Medicare pays 55 percent of its approved amount. You or your supplemental insurer are responsible for the remainder of the bill (20 percent or 45 percent coinsurance, respectively).

These are among the mental health services Medicare covers:
• Individual and group therapy.
• Family counseling to help with your treatment.
• Tests to make sure you are getting the right care.
• Activity therapies, like art, dance or music therapy.
• Occupational therapy.
• Training and education (like training on how to inject a needed medication or education about your condition).
• Substance abuse treatment.
• Laboratory tests.
• Prescription drugs that you cannot administer yourself, like injections that a doctor must give you.

You are correct that the Mental Health Parity and Addiction Equity Act of 2008 prohibits insurers from charging more for mental services than other services, but the law applies only to employment-based insurance plans. Thus, Medicare is not affected. But under the Medicare Improvement for Patients and Providers Act of 2008, Medicare coinsurance for mental health services will be gradually reduced over the next five years. This year and next year, consumers will pay 45 percent for most mental health services, in 2012, they will pay 40 percent, in 2013 they will pay 35 percent and by 2014, consumers will pay 20 percent — just as they do for most other services.

The Medicare improvement law will not change how Medicare covers inpatient mental health services. If you receive care in a psychiatric hospital, Medicare helps pay for up to 190 days of inpatient care in your lifetime. After you have reached that limit, Medicare may help pay for mental health care at a general hospital. Your out-of-pocket costs are the same in a psychiatric hospital as they are in any hospital. In February, Senators John Kerry and Olympia Snowe introduced the Medicare Mental Health Inpatient Equity Act, which would eliminate the 190-day limit on inpatient psychiatric hospital stays and cover inpatient psychiatric hospital stays much as it does all other hospital stays under Medicare. Congress has yet to take action on this legislation.


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    This is Drexel University’s IRS 2008 Form 990. Go to page 10, to see the Compensation of the Five Highest Paid Employees Other Than Officers, Directors and Trustees.

    Roger Dennis, dean of the provisionally accredited piece of trash known to the world as the Earle Macke School of Law, made $308,490 in salary PLUS $32,074 in contributions to employee benefit plans & deferred compensation. That would bring his TOTAL COMPENSATION - for 2007 - to $340,564.

    This makes Dennis the THIRD HIGHEST PAID EMPLOYEE of Drexel University, in terms of salary, and fifth highest paid with regards to total compensation. Apparently, higher education does pay off.

    Let's beat the hell out of the Drexel trolls on my TTR post featuring this commode of law.