Statements on Introduced Bills and Joint Resolution

Floor Speech

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Ms. COLLINS. Mr. President, I rise today to introduce the Medicare Mental Health Inpatient Equity Act, legislation that eliminates Medicare's arbitrary 190-day lifetime cap on inpatient services in psychiatric hospitals. This change is long overdue given the steps that Congress has taken to improve coverage of mental health services. I am pleased to be joined by Senator Tina Smith (D-MN), who has been a champion for greater access to mental health care.

Left untreated, mental illnesses are some of the most disabling and destructive illnesses afflicting Americans. Unfortunately, our current mental health system is fragmented, and family members with serious mental illness all too often lack access to the care that they need. That is why I have worked consistently and vigorously to improve mental health services across the lifespan.

I was an original cosponsor of the Senator Paul Wellstone Mental Health Parity Act, a landmark law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical and surgical benefits. I was a longtime supporter of the Excellence in Mental Health Act, which increased Americans' access to community mental health and substance use treatment services through the Certified Community Behavioral Health Clinic (CCBHC). I have also worked with my colleagues Senator Durbin and Senator Portman to support greater residential treatment options by modifying Medicaid's restrictive Institute of Mental Disease exclusion as part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the ``SUPPORT Act'').

As chairman of the Aging Committee, I also recognize that seniors have significant unmet mental health needs and that their Medicare coverage can be greatly improved. I was an original cosponsor of the Medicare Mental Health Copayment Equity Act, which was signed into law in 2008, that eliminated higher outpatient copayments for mental health services I have also recently re-introduced legislation with Senator Brown that would update the Medicare program by recognizing clinical psychologists as independent care providers, thus expanding mental health care options and access for Medicare beneficiaries.

The legislation I am introducing today breaks down another barrier in Medicare, the 190-day lifetime cap on inpatient services in psychiatric hospitals. No other Medicare inpatient service has these types of arbitrary caps, which is why elimination of Medicare's lifetime cap was a recommendation of the 2016 White House Mental Health and Substance Use Disorder Parity Task Force.

I recognize that this cap was originally intended to limit the federal government's role in paying for long-term custodial support of the mentally ill. And no one wants to go back to the abusive days of long term institutionalization, which is why l have championed so many measures to help bolster community mental health resources. At the same time, keeping a cap on inpatient days at psychiatric hospitals-- particularly for patients who have been living with serious mental illness from a young age--undermines patient treatment options and can lead to disruptive transitions of care. Many general hospitals lack psychiatric capacity and there are countless examples across the country of psychiatric boarding in emergency departments. Skilled nursing facilities may not be best suited to provide the complex and specialized psychiatric care these beneficiaries need. Finally, too many patients find themselves receiving care in prisons.

According to a 2019 Mathematica report commissioned by the Department of Health and Human Services, most fee-for-service Medicare beneficiaries who use inpatient psychiatric facilities have primary diagnoses of schizophrenia, major depressive disorder, and bipolar disorder, but Alzheimer's and related diagnoses are also common. We need to help patients with serious mental illness recover regardless of the setting where they are receiving care. The Medicare Mental Health Inpatient Equity Act is supported by a wide range of mental health groups, including the National Association of Behavioral Healthcare, the American Psychiatric Association, the American Psychological Association, and Mental Health America.

I urge my colleagues to support this legislation.

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