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Coalition Holds Congressional Briefing on Medicare Coverage for Substance Use Disorder Care
The American Society of Addiction Medicine, the Legal Action Center (LAC), the National Council for Mental Wellbeing, the Illinois Association for Behavioral Health, and the National Association of Social Workers held a briefing on Medicare coverage for substance use disorder (SUD) care on February 15th, 2024, in coordination with the Addiction, Treatment, and Recovery (ATR) Caucus, and sponsored by the Coalition for Whole Health and the Mental Health Liaison Group.
There are at least four million adults over the age of 65 with SUD in the U.S., while drug overdose deaths among older adults have more than quadrupled over the past two decades. Representative Paul Tonko (NY-20) of the ATR Caucus highlighted the event and said, "“Far too many of our family, friends, and neighbors struggling with the disease of addiction do not receive the treatment they need. We can and must do better for our community and for our loved ones. We must combat cruelty with compassion and work to ensure that everyone in need of SUD treatment has access to it."
Paul Samuels, President and Director, and Deborah Steinberg, Senior Health Policy Attorney, LAC, moderated the event. Steinberg said "to make treatment truly affordable and accessible and to decrease the stigma around SUD and mental health conditions, it is necessary to fix Medicare's coverage gaps, so such conditions have the same level of insurance coverage as medical conditions.” Steinberg further noted, “removing the discriminatory barriers for SUD and mental health treatment is the meaning of equitable insurance coverage, or parity -- to address this epidemic, we must ensure older adults and people with chronic disabilities have access to non-discriminatory SUD care."
Panelists' remarks included:
- Dr. Corey Waller, Editor in Chief of the ASAM Criteria, who pointed out that in addition to the lack of parity in Medicare, it fails to cover all of the evidence-based services that are reasonable and necessary for the treatment of SUD. Dr. Waller described the full continuum of SUD care that Medicare must cover for beneficiaries to receive their needed and appropriate level of care, and noted this will ultimately help America save in costs from unnecessary and costly emergency department visits and hospitalizations.
- Ms. Kelly Epperson, Chief of Staff and General Counsel for Rosecrance in IL, spoke about the residential level of care for SUD treatment that is still not covered by Medicare, despite the many residential treatment providers that deliver evidence-based addiction and mental health treatment across the country.
- Additionally, Medicare does not cover all of the community-based settings for SUD care, including specialty community-based SUD treatment facilities and certified community behavioral health clinics (CCBHCs). Ms. Natalie Cook, Vice President of CLIVE Solutions, representing the Missouri Behavioral Health Council, highlighted the need for Medicare to cover some such settings that provide comprehensive addiction treatment.
- Finally, Ms. Catherine Lawder, a licensed clinical social worker from Virginia, described how rules for Medicare coverage limit the scope of how social workers can treat Medicare beneficiaries, and pay discriminatorily low rates for such workers compared to other medical providers, exacerbating America's mental health and SUD workforce crisis.