Bills
| 3.23.22

Expanding Access to Mental Health Care Through Medicare and Medicaid (H.R. 2646)

Do you support or oppose this bill?

What is H.R. 2646?

(Updated February 26, 2020)

This bill would reform the way that psychiatric, psychological, and support services for individuals with mental illness are provided to patients and families going through mental health crisis. It covers federal patient privacy policies, reforms to mental health coverage under Medicare and Medicaid, and federal grant programs.

Under the Health Insurance Portability and Accountability Act (HIPAA) health care providers are required to comply with certain recordkeeping and patient privacy regulations. Individuals who have serious mental illness would be excepted from some HIPAA privacy regulations so that health information can be disclosed to their caregivers. Caregivers would also be able to access education records protected by the Family Educational Rights and Privacy Act (FERPA).

Medicaid would cover payments for mental health services that are provided on the same day as primary care services, and states would have the option of covering inpatient psychiatric services to non-elderly adults. A 190-day lifetime limit on inpatient psychiatric care imposed by Medicare would be eliminated so long as the Centers for Medicare and Medicaid Services certify that the elimination wouldn’t increase federal spending. Both Medicare and Medicaid would cover prescription drugs used to treat mental health disorders.

Federal grants for the treatment of mental illness would be made available for mental health care providers such as state and local governments, educational institutions, and nonprofits. Among these grants would include:

  • Innovation grants for entities that have scientifically demonstrated a method of enhancing the screening, diagnosis, and treatment of mental illness or integrating physical, mental health, and substance abuse services;

  • Demonstration grants for organizations to expand, replicate, or scale evidence-based programs to train staff or apply care delivery techniques, and integrating models of care across specialties;

  • Early childhood intervention and treatment programs to prevent chronic and serious mental illness at preschool and elementary school age;

  • Workforce development grants that would go to 10 eligible states to train primary care physicians in recognizing signs of mental illness.

Funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) would be reauthorized, which provides support in the process of improving the availability and delivery of prevention, treatment, and rehabilitative services to those who need them. These provisions include further reforms to ensure that caregivers can access the health information of patients with serious mental illnesses.

Argument in favor

There is a mental health crisis in U.S. today, and far too many Americans go without needed treatment. This bill takes reasonable steps to make mental health care more accessible.

Argument opposed

Allowing the caregivers of mentally ill patients to access the patient’s protected health information undermines the privacy protections of HIPAA and will lead to abuse of those records.

Impact

Those people receiving treatment for mental illness — particularly if covered by Medicare and Medicaid — and their families, mental health care providers, state and local governments, and the Dept. of Health and Human Services (HHS).

Cost of H.R. 2646

The CBO estimates that the Medicare and Medicaid reforms contained within this bill would increase spending by about $3 billion over the 2016-2024 period.

Additional Info

In-Depth: Following its introduction by Rep. Tim Murphy (R-PA), this bill received the support of House Speaker Paul Ryan (R-WI) following a shooting at a Colorado Planned Parenthood Clinic:

“What happened is appalling and justice should be swift. Clearly we can do more, and one common denominator in these tragedies is mental illness… I’m sure members of both parties have lots of ideas in this area, but we should make this a priority to prevent the violence and to protect our citizens.”

Some Democrats have expressed opposition to the loosening of privacy protections to share mentally ill patient’s protected health information with the patient’s caregiver, but that hasn’t deterred bipartisan lawmakers from supporting this bill. Currently it has 166 cosponsors in the House, including 46 Democrats and 120 Republicans.

This bill was passed by the House Energy and Commerce Committee’s Subcommittee on Health on a vote of 18-12. The full committee will now consider it before it moves to the floor of the House.


Media:

Summary by Eric Revell
(Photo Credit: dierkschaefer )