Under the new health-care legislation mental health and substance use disorder benefits must be offered on a parity with other medical and surgical benefits for all insurance plans. There can be no annual or lifetime limits or denial of benefits based on pre-existing conditions. There will be special support for the delivery of services, education and research for depression. The increased Medicaid eligibility will provide more mental health services and there will be some special demonstration projects under Medicaid. There is a 5% increase scheduled for psychotherapy services under Medicare. However there are some complicated issues concerning Medicare rates which need to be worked out including the feasibility of psychotherapy being provided under the prevailing fee schedule.
Tierra del Sol is a non profit organization serving people who are developmentally disabled. It has a small campus in Sunland, California where each day 250 adults are bussed in to participate is an individually designed curriculum. The programs include farm work, computer learning, art classes and kitchen training. People with developmental disabilities have a high prevalence of mental health problems, which can be difficult to diagnose. Mental health services for this group are more time consuming and therefore more expensive. As we are reevaluation our health care system in the U.S., this is the time to be sure that adequate mental health care for this is group is included in our health care program.
The author describes his experience of wishing a patient in psychotherapy a happy 65th birthday and telling the patient that his fee is now reduced since he is now on Medicare. Opting out of Medicare is discussed as well as the implications of new healthcare changes which may discourage psychiatrists from doing psychotherapy.