NNews March 2024

9 March 2024 According to LAC, more than one million Medicare beneficiaries have SUD and 84% of them did not receive treatment in the past year. In addition, as revealed by the National Survey on Drug Use and Health, 38% of Medicare beneficiaries aged 65 and older reported financial barriers, including lack of insurance coverage, as a reason for not receiving SUD treatment; and 50% of Medicare beneficiaries who are Black and Hispanic, compared to 36%who areWhite, are enrolled in Medicare Advantage plans, which impose more limitations on accessing SUD care than traditional Medicare. “Medicare does not cover the full continuumof services recognized by the American Society of AddictionMedicine, or the range of providers and the settings needed for treatment. Medicare is also not subject to theMental Health Parity and Addiction Equity Act, which protects people with SUD andmental health conditions from discrimination. As a result, many Medicare beneficiaries receive inadequate, if any, treatment until their conditions become acute enough to require hospitalization,” the LAC states on its website. With the 30+ organizations participating on the Learning Collaborative, the MAPP developed a comprehensive set of legislative and regulatory policy recommendations to modernize Medicare to meet the needs of individuals with SUDs. “In Congress in the past year, Medicare coverage was expanded to include intensive outpatient SUD treatment, as well asmental health counselors, which include substance use counselors and licensedmarriage and family therapists,” Steinberg said. “Since working towardMedicare parity, Congress now requires the U.S. Government Accountability Office to study disparities in Medicare in mental health and SUD treatment compared tomedical and surgical care. The Centers for Medicare andMedicaid Services (CMS) is improving network adequacy standards, employing standardwait metrics and is limiting the use of prior authorizations. In addition, opioid treatment programs are now in outpatient facilities, and the reimbursement rate has been increased; and there is now coverage for some peer support services to address addictions and social determinants of health for Medicare beneficiaries,” she added. “We are excited that our goal for parity in Medicare is gaining attention and awareness. Legislation has already been introduced to address gaps in Medicare,” Steinberg said, referring to the Better Mental Health Care for Americans Act (S.923), which is sponsored by Senators Michael Bennet (D-CO) and RonWyden (D-OR). In addition, Representatives Bill Pascrell, Jr. (D-NJ), Judy Chu (D-CA) and Adrian Smith (R-NE) sponsored H.R. 8878 to create a new benefit category within Medicare Part B for coverage of intensive outpatient mental health care. The bill was introduced in September 2022 and included in the Consolidated Appropriations Act of 2023. LAC Also Focuses on Medicaid and Commercial Insurance Samuels shared that as a result of LAC’s advocacy, CMS has granted waivers to two states to use Medicaid in the last 90 days before individuals’ release from jail and prison and to connect them to care upon their release. “This is an enormous game changer, to have a real funding stream to support this work. Continuing waivers will lead to a law and helping many more people,” he said. LAC is also advocating for parity in Medicaid and commercial insurance, and programs in many states have already reduced requirements for prior authorizations. “ We create and protect legal rights for people with substance use disorder, mental illness, HIV and/or criminal justice backgrounds. ” Paul N. Samuels, JD Director/President (continued on page 10)