In recognition of Older Americans' Mental Health Week (May 24-30, 2009), this Weekly Alert reviews the mental health services that are available under the Medicare Program.  Advocates seek improved access to mental health services, an expansion in the scope of services covered, and an increase in the types of providers whose services are covered. For example, transportation to obtain mental health care services is not covered, nor is there Medicare coverage for beneficiary testing and training for skills for various occupations.
While work remains to be done, we can celebrate the advances in Medicare payment parity for mental health services made last summer in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), Pub. L. 110-275 (July 15, 2008). Under that law, beginning in 2010, there is a reduction in the cost-sharing related to the treatment of outpatient psychiatric services. By 2014, beneficiaries will pay the standard 20% coinsurance rate for Part B services.
An Overview of Mental Health Services Coverage under Medicare
Inpatient Hospital Services
Hospital-based inpatient care is available for mental health treatment under Part A. Inpatient care is health care received when a beneficiary stays in a hospital overnight. However, Medicare limits coverage for inpatient care in a Medicare-certified specialty psychiatric hospital to 190 days during a beneficiary's lifetime.  Beneficiaries may be able to receive additional mental health care after using the 190-day limit if they are admitted into a Medicare-certified general hospital. 
If more intensive outpatient care is the best treatment for a particular beneficiary, Medicare may cover what is known as partial hospitalization treatment. A beneficiary's doctor must verify that a person would otherwise need inpatient treatment. Partial hospitalization treatment is typically performed through hospital outpatient departments and local community mental health centers.
Outpatient Services for mental health diagnosis and treatment are covered under Medicare Part B and consist of services that are usually given outside of a hospital and do not require an overnight stay. Part B also covers physician and therapist services while the beneficiary is still in the hospital, and beneficiaries pay 20% in co-insurance for these charges.
For outpatient mental health treatment, it is important to be aware that there is currently a special, more expensive 50% coinsurance rate for outpatient mental health services such as individual, family, and group psychotherapy, and for therapeutic activity and patient education services that are related to the treatment and follow-up diagnostic services for a mental, psychoneurotic, or personality disorder, rather than the initial diagnosis. As discussed above, this inequity in payment is being phased out over the next five years.
Prior to receiving mental health services, the beneficiary should confirm that the mental health professional accepts Medicare payment. Also, ask whether the independent mental health care provider will accept Medicare assignment, as this could result in cost savings for the beneficiary. Clinical psychologists and social workers must accept assignment, whereas physicians may choose to refuse assignment and require additional payment from the Medicare beneficiary. 
Mental Health Providers Eligible for Medicare Payment
The following independent mental health providers may be eligible for direct payment from Medicare:
clinical social workers
clinical psychiatric nurse specialists; and
nurse practitioners with the equivalent of a master's degree in psychotherapy. 
Payment for Psychotropic Medications
Prescription psychotropic drugs are covered for Part D enrollees in private, stand-alone prescription drug plans and for those with drug coverage offered by Medicare Advantage plans through Part C. While each drug plan can decide which drugs to include on its formulary, every plan must include all or substantially all drugs that fall within six protected classes of drugs. Antidepressant and antipsychotic drugs are among the six classes that must be included. However, benzodiazepines and barbiturates, often used as tranquilizing drugs or drugs to treat other mental disorders are currently excluded under Medicare Part D coverage rules.
Mental health is an essential component to overall health. Advocates should continue to work to increase the scope of mental health services covered by Medicare, which should include support services such as transportation, as well as testing and training for job assistance. In addition, advocacy is necessary to reduce the disparity in co-payments applicable to mental health as compared to other healthcare services.