Dialysis companies pay into a fund that then pays Medigap premiums for those dialysis patients who can’t afford to pay for it themselves therefore ensuring they will get the 20% co-pay they might otherwise have to eat or wait years to get paid. Medigap for psychiatric care is an even better deal since the co-pay for psychiatric services under Medicare is still 50% instead of 80% and won’t reach 80% parity for several years. Some states have figured this out and pay the Medigap premiums of citizens with disabilities who would not otherwise be able to afford them thus saving the state money when services the state provides anyway are reimbursed at 100% instead of 50%. But not Virginia. I brought this up twice at Commission on Mental Health Law Reform Commission meetings but I have not heard a word about follow up in the Access to Services group that is now working in secret with members chosen for their likelihood of avoiding conflict and all the troublemakers who disagreed with the majority openly pushed out of discussions in all the committees whose names have not even been released, let alone their membership lists. Trouble with avoiding “trouble-makers”? You avoid fresh and different ideas at the same time and you don’t have all the ideas and facts you need to come up with the best proposals. But never mind, consensus and going along to get along is all that really matters. Back to the issue at hand.
We have many clients of Community Service Boards in Virginia who have Medicare coverage but do not have Medigap coverage to pay for the other 50% not paid for by Medicare. There are a few things the state could do about this that would help a lot in ensuring more services and more money for services. One would be to offer Medigap coverage from a state insurer to people under 65 on disability or to reimburse an existing insurer for doing it. Some folks could afford to pay their own premiums and might leave the CSB system altogether for private care if they had full insurance coverage thus saving the state money. For those who could not afford the premium themselves, it would still save the state money to pay the premium for them so that services would be covered at 100% of Medicare rates. Medicare rates for psychotherapy and for medication management are much higher than Medicaid rates and unlike Virginia’s Medicaid reimbursement for psychotherapy have actually pretty much kept pace with inflation. So instead of 20 something dollars per session a CSB could receive $65 a session with a licensed social worker and much more for a licensed psychiatrist or psychologist. CSB’s already employ LCSW’s and psychiatrists but do not collect that kind of money for their services at all.
Of course Medicare will not pay for day warehousing, oops, I mean clubhouses nor for Persistent Annoying Community Treatment teams, oops, I mean PACT teams, CSB’s would have to provide individualized treatment by individual providers instead but hey, guess what? There is evidence that psychotherapy and medication management on an individualized basis is the gold standard of treatment for “serious mental illness” just like it always was, propaganda from PACT and MOT supporters notwithstanding.
So hey, could we possibly look at doing something that would pay for itself while increasing reimbursement for and availability of mental health treatment to Virginians who want and need it? Nah. We have to do what the people in charge want, whatever that is, but it seems to be to pay for treatment by forcing it on both citizens and CSB’s even if coerced treatment is both less effective and less attractive to everyone involved, patients and providers both. Let’s not do anything that makes common sense and pleases users of services, that would be……..wrong? What could dialysis companies that struggle against a lack of rising reimbursement know about staying in business anyway? They make a profit but that couldn’t be because they take a sensible approach to Medicare and Medigap coverage for their patients? Nah. Couldn’t be.
