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Author Topic: BAILOUT/MENTAL HEALTH PARITY  (Read 974 times)
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« on: October 04, 2008, 12:43:42 AM »

    It appears that the current version of the bailout has passed. Ushered in with the bailout is something called "Mental Health Parity". This piece of legislation was attached to the bailout, along with other servings of pork, as incentive for members of congress to change their vote from "Nay" to Yea".

    The American Public has no idea what the implications of the Mental Health Parity is going to be. I'm not sure that I grasp the entire scope, but let me share with you what I do know. I have a small Rural Health Clinic and employ a Physician, 3 Nurse Practitioners, and a Licensed Clinical Social Worker, as providers for services to patients. Mine was the first Rural Health Clinic to offer mental health services in the entire State of Virginia, a fact that turned provider education departments at CMS on its' head in terms of coding and billing. They were literally creating rules for us that we insisted on getting in writing, that we faithfully kept under lock and key in the event our billing practices were ever questioned by an auditor.

    The reason that mental health services were so rare is because there is a "psychiatric reduction" embedded in the calculations for reimbursement. Basically, a provider rendering therapeutic services to a patient will receive 37% less from Medicare than if services were rendered for a medical diagnosis. We offered those services only because I had previously come from work experience in billing for psychiatric services, so there was no learning curve and I had the software to do it, and I had key staff with a background in the field. My objective was to meet a need and loose no money, so I hired an LCSW who agreed to work as a 1099.......paid based on fee per service. I still lost money for the first year and a half for the mental health services, but was able to carry it with the Medical services we were providing (the bulk of the clinic). Since then, I have managed to continue the services with a small margin of profit because of an increase in mental health patient load.

    The Mental Health Parity that has been attached to the bailout changes all that. Simply stated, it requires insurance companies
that offer Mental Health coverage, to make no difference in coverage, limits, or reimbursement for mental health services as that of medical or surgical services. Here's the implications of that, both good and bad:

  • More Mental Health Services will be available because practices will want to capture the new funding
  • Private Insurances will drop coverage for Mental Health Services all together, because these services traditionally have a longer treatment span than medical cases, and the incident of chronic illness is higher than that of medical
  • Mental Health services will be available primarily to Medicare and Medicaid patients. Those publically funded Insurance programs will be required to include coverage.
  • The increased cost for providing these services with public money will be in the BILLIONS

I will reap benefits from the legislation and do believe that patients in need of mental health services, under the present system, are discriminated against, but am outraged that it has been added at this time. We are being saddled with a 700 billion dollar bill and it's been slid under our noses without a price tag. I don't know what the figure would be if the 37% increase were just added to those currently offering services, but that wouldn't be an accurate indicator, because I guarantee you that there are multitudes of practices that are tonight laying plans to begin to offer a mental health component in order to capture the newly released dollars under the bailout.

I hate to be the bearer of bad news, but since we all are going to be paying the bill, I, at least, thought you should know. I think it's wrong, at this time, to add this to an already overwhelming burden on the American people. Somebody in congress needs to grasp the need to stop spending!!
« Last Edit: October 04, 2008, 04:07:27 AM by crazybabyborg » Logged
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