One of Medicare’s biggest problems is limited access to mental health services for older people.
Cooper said Medicare only allows psychologists, psychiatrists, licensed clinical social workers and nurses to provide care to older people. The Centers for Medicare & Medicaid Services has published the proposed 2023 Physician Fee Schedule (PFS) rule. This announces and requests public comment proposed policy changes to Medicare payments based on the Physician Fee Schedule (PFS) and other Medicare Part B payment policy issues.
“It’s not enough, it’s impossible to find psychiatric time, a psychologist or a licensed clinical social worker,” Cooper said. “This newly proposed regulation is meant to allow marriage and family therapists and other mental health professionals to bill Medicare. It will help.”
The proposal includes modernizing the coverage of behavioral health services to allow licensed professional counselors, marriage and family therapists, and other types of practitioners to bill Medicare under general supervision. This includes improving access and quality. Licensed clinical psychologist to provide integrated behavioral health services as part of the patient’s primary care team, allowing the psychiatric diagnostic assessment to serve as the first visit for behavioral health integration Pay a clinical social worker. Bundle selected chronic pain management and treatment services into a new monthly payment. Cooper said it covers treatment and recovery services from mobile units.
Cooper, who is being treated for depression, said she lost her counselor the day she turned 65. Her counselor was unable to bill Medicare. This is because that particular coverage does not cover master’s-level licensed marriage and family therapists.
“These new regulations allow her to do so,” she said. “I was able to find a new therapist, but it took me six months on the waiting list. The only reason they accepted me was because I had supplemental Medicare insurance. If I only had Medicare, they wouldn’t accept me.
Jessica Cohick, PA MEDI Local Coordinator for the Northumberland Department of Aging, not only helps Medicare beneficiaries find insurance, but also PACE/PACEnet, Extra Help, Medicare Savings Programs, and in some cases Medicaid. said it would help them access the benefits of The program is free and offers insurance counseling to all Medicare beneficiaries, regardless of age, to help them choose the insurance that best suits their needs.
Traditional Medicare covers mental health care services such as depression and anxiety, including counseling and psychotherapy, Kohick said.
“Coverage typically includes services provided in ambulatory settings such as clinics and hospital outpatient departments,” Cohick said. “These services may include visits with a psychiatrist or other physician, clinical psychologist, clinical nursing specialist, clinical social worker, nurse practitioner, or physician assistant. includes partial inpatient services, which are intensive outpatient mental health services provided during the day, which are provided by hospitals to outpatients or by community mental health centers. increase.”
Cohick said beneficiaries typically pay 20 percent of Medicare-approved amounts, with Part B deductibles applied to mental health care services.
“This is how Medicare traditionally works, but beneficiaries can purchase other insurance to help with their health care coverage, such as Medicare Supplements (Medigap) and Medicare Advantage Plans. It applies,” she said. “However, if a beneficiary chooses to enroll in an Advantage Her plan, the beneficiary is subject to the guidelines of that plan.”
As with any insurance policy, there are a few things subscribers must do to access the service, Cohick said.
“The type of secondary insurance a beneficiary chooses can affect the ease of service delivery,” said Cohick. “If the beneficiary has a traditional Medicare or Medigap plan, the beneficiary can look anywhere Medicare is accepted. However, as mentioned above, as long as the provider accepts Medicare, it can be scheduled.If the beneficiary chooses an Advantage plan (usually a PPO or HMO) You will need to find a provider that will accept you and pay any co-payments due according to the rules of your plan.”
Some of the challenges that exist in accessing mental health services for older adults is transportation, an ongoing problem for many of the Valley’s residents and providers who do not accept certain insurances.
Karen Leonovich, administrator of the Northumberland County Regional Department on Aging, said Kohick was a “third party without an opinion.”
“If you go to your local insurer, you can discuss the same issues, but they tend to pitch specific plans,” says Leonovich. “Jess reviews all plans and is not biased towards any one. She is there to provide information and make changes if there is interest.”
