Congress Urged to Act to Ensure Millions of Medicare Beneficiaries Can Access Life-saving Treatment
FOR IMMEDIATE RELEASE:
July 27, 2022
Washington, DC: The Legal Action Center, Center for Medicare Advocacy, and Medicare Rights Center today released a set of legislative principles for Congress to use as it considers additional policies in the Medicare program to better address the escalating overdose and mental health crises.
An estimated 1.7 million Medicare beneficiaries are living with a diagnosed substance use disorder (SUD) and 1 in 4 Medicare beneficiaries are living with a mental health condition. But Medicare does not cover the full continuum of services recognized by the American Society of Addiction Medicine, nor the range of providers and settings needed for effective, evidence-based treatment. Neither is Medicare subject to the Mental Health Parity and Addiction Equity Act (Parity Act), which protects people with SUD and mental health conditions from insurance discrimination. As a result, millions of Americans who depend on Medicare are unable to receive the life-saving treatment they need and deserve. Untreated substance use disorders increase the risk of death and lead to other medical conditions, which often require additional services and ultimately raise Medicare costs.
The principles released today seek to close this treatment gap by expanding Medicare coverage to include the full continuum of treatment and match the care delivery infrastructure for addiction and mental health that exists in other payer systems. Specifically, the principles would apply the Parity Act to Medicare Parts A, B, C and D, authorize coverage of the full continuum of evidence-based SUD treatment services, authorize coverage of community-based SUD treatment settings, authorize coverage of all licensed and certified mental health and SUD treatment providers, and establish adequate reimbursement rates. As a whole, these policy changes would ensure greater consistency across insurance types and continuity of care for Medicare-eligible individuals.
“Because of Medicare’s limited coverage, millions of beneficiaries remain unable to access adequate treatment for their substance use disorder until their conditions become acute enough to require hospitalization. It’s time to fix this unacceptable problem and apply the parity principles to Medicare. By enacting these changes, Congress can usher in a historic and desperately needed modernization of Medicare, ensuring the needs of millions of individuals with SUDs can be met while eliminating discriminatory treatment practices and ultimately saving countless lives,” said Ellen Weber, LAC’s Senior Vice President for Health Initiatives.
“The principles we jointly released reflect the Medicare expansions necessary to meet the needs of the millions of Medicare beneficiaries who are struggling without coverage for comprehensive treatment for substance use disorder and mental health conditions,” said Judith Stein, Executive Director of the Center for Medicare Advocacy.
“Both equity and urgency demand that we close gaps in Medicare’s substance use disorder and behavioral health coverage. It is past time to apply parity to Medicare and ensure older adults and people with disabilities can access the full scope of treatment and the providers they need,” said Fred Riccardi, President of the Medicare Rights Center.
In June, 245 national, state, and local organizations and advocates signed on to a letter urging Congress to apply the Parity Act to Medicare Parts A, B, C, and D, as well as take other steps to improve treatment coverage and access for Medicare beneficiaries. This work is part of LAC’s Medicare Addiction Parity Project, which was established in 2021 to increase access to substance use disorder care in Medicare, the federal program that provides health insurance coverage to individuals ages 65 and older, as well as younger individuals with long-term disabilities.