One of the biggest problems with Medicare is the limited access older adults have to mental health services, according to Lynn Cooper, a behavioral health specialist with the Pennsylvania Association of Area Agencies on Aging.
Cooper said Medicare only allows licensed psychologists, psychiatrists, clinical social workers and nurse practitioners to provide therapy to older adults. The Centers for Medicare & Medicaid Services has issued a proposed rule for the 2023 Physician Fee Schedule (PFS) announcing and soliciting public comment on proposed policy changes to Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B payment policy issues.
“It’s not enough, and it’s impossible to find psychiatric time, to find psychologists and licensed 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 through this, this will help our mental health providers a lot.”
Proposals include modernizing coverage for behavioral health services and improving access and quality by allowing licensed professional counselors, marriage and family therapists, and other types of professionals to bill Medicare under general supervision; allow psychiatric diagnostic evaluations to serve as the initial visit for behavioral health integration and pay for licensed clinical psychologists and clinical social workers who provide integrated behavioral health services as part of a patient’s primary care team; bundle certain chronic pain management and treatment services into new monthly payments; and covering mobile unit treatment and recovery services, Cooper said.
Cooper, who is undergoing therapy for depression, said he lost his counselor on his 65th birthday. Her counselor couldn’t bill Medicare because that specific coverage doesn’t cover a master’s-level licensed marriage and family therapist.
“These new regulations would allow you to do so,” he said. “I was able to find a new therapist, but it took me six months on a waiting list. The only reason I was accepted was because I have a supplemental insurance policy to my Medicare. If I only had Medicare, they wouldn’t take me. The rate is so terribly low that it doesn’t even cover its cost.”
Jessica Cohick, local coordinator for PA MEDI with the Northumberland County Area Agency for Aging, said it helps Medicare beneficiaries find insurance and helps them 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 counseling to help them select the insurance that best suits their needs.
Traditional Medicare covers mental health care services for conditions like depression and anxiety, such as counseling or psychotherapy, Cohick said.
“Coverage includes services that are normally provided in an outpatient setting, such as a doctor’s office or hospital outpatient department,” Cohick said. “These services may include visits with 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 center.
Typically, Cohick said, the beneficiary will pay 20 percent of the Medicare-approved amount, and the Part B deductible applies for mental health care services.
“Although 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, the Medicare rules will apply,” she said. “However, if a beneficiary chooses to enroll in an Advantage plan, the beneficiary will be subject to that plan’s guidelines.”
As with any insurance, there are certain things members must do to access services, Cohick said.
“The type of secondary insurance a beneficiary selects can affect the ease with which services are provided,” Cohick said. “If a beneficiary is enrolled in traditional Medicare or a Medigap plan, the beneficiary can be seen anywhere Medicare is accepted. There could be deductibles and coinsurance, depending on the Medigap plan they have, but as mentioned, as long as that provider accepts Medicare, you’ll be able to make an appointment. If a beneficiary has selected an Advantage plan, usually a PPO or HMO, they will need to find a provider that accepts their plan and pay any copayments that are due according to plan rules.”
Some of the challenges that exist when it comes to older adults accessing mental health services would be transportation, which is an ongoing issue for many Valley residents, as well as providers who don’t accept certain insurances, Cohick said. .
Karen Leonovich, administrator of the Northumberland County Area Agency on Aging, said Cohick is a “third party with no opinion.”
“You can go to a local insurance company and they will talk to you about the same things, but they tend to sell you their specific plan,” Leonovich said. “Jess will look at all the plans and he is not biased towards any of them. She is there to provide information and make changes if she is interested.”