National Alliance on Mental Illness
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Background on the Medicare Improvements for Patients and Providers Act of 2008

June 26, 2008

Congress is now under extreme pressure to act on Medicare legislation.  The President and Congress must act by July 1 to extend the physician payment update (known as SGR).  If Congress does not act, the Part B physician payment update will expire and reimbursement rates for physicians will be cut.   Complicating this situation is the possibility of a Presidential veto. 

This political imperative to act on Medicare has created the opportunity for Congress to move on a series of beneficiary improvements and protections – including a rage of NAMI priorities such as adjustments to the Part D drug benefit and parity for cost sharing for outpatient services.  On June 12, the Senate fell 6 votes short of moving on a Medicare bill (S 3101) developed by Senate Finance Committee Chairman Max Baucus (D-MT).

The House is expected to vote on a similar package (HR 6331) on June 24.  Among the critical NAMI priorities in both the House and Senate bills is:

  • Parity for cost sharing for outpatient mental health services under Part B, gradually moving the current discriminatory 50% requirement down to 20% between 2010 and 2014
  • Statutory authority under the Part D drug benefit for the Centers for Medicare and Medicaid Services (CMS) to ensure broad coverage on prescription drug plan formularies for antipsychotics, antidepressants and anticonvulsants,
  • Removal of the current ban on Part D plans offering coverage for benzodiazepines (a critical tool in treatment for acute mania in bipolar disorder and severe anxiety disorders),
  • Changes to eligibility for the Part D Low-Income Subsidy (LIS) program (also known as “Extra Help”) – These reforms include an increase the amount of allowable resources, elimination of barriers to enrollment and the current late enrollment penalty and new exemptions for the value of a life insurance policy and in-kind support and maintenance.  Eligibility for the LIS significantly lowers and premiums and cost sharing for drug coverage and exempts beneficiaries from the “doughnut hole” coverage gap.