MENTAL HEALTH CARE PAYMENT OPTIONS UNDER MEDICARE PART B

最近，医疗保险B部分的覆盖范围发生了重大变化， 精神卫生服务：逐步取消覆盖范围限制， 医疗管理服务的限额（和50%的共同保险 以及将直接报销扩大到心理学家和 社工 拟议的两年研究旨在填补研究 医疗保险B部分下的心理健康费用和使用方面的差距，特别是在 根据最近的福利设计变化。 这项研究特别及时 在实施基于资源的相对价值量表的前夕 医生报销。 这项研究将提供重要的基线 根据RBRVS进行支付改革之前的信息。 将使用两个B部分数据库：一个包含所有5 全国受益人随机抽样百分比（BMAD）和所有 对10个国家受益人群体的索赔， 几乎占全国医疗保险受益人的四分之一。 的解析 时间段为1987年至1991年，1987年为 覆盖范围变更前的基线期。 两个分析任务是 建议：（1）B部分精神健康开支的基线和趋势分析 并使用国家BMAD文件;和（2） 使用十州数据库的时间利用模式。 此外 审查限额提高前后的使用模式 (and最终消除），该研究将审查直接影响 费用和使用的补偿。 此外，三个特定程序 建议分析医疗管理服务的使用情况， 住院服务和ECT治疗。 这项研究还将预测 将共同保险费率从50%降低到20%的成本， 实现医疗和外科服务的平等。 这项研究将产生三个重要成果：一个全面的数据 关于美国医疗保险和心理健康服务的书（1987-1991）; 关于10个州受益者使用模式的深入报告， 政策影响的讨论;以及一组分析文件， B部分精神健康索赔的五年时间序列，可用于 继续研究医疗保险和精神卫生服务， 医疗保险B部分。

Significant changes have recently occurred in Medicare Part B coverage of mental health services: gradually phasing out the coverage limit, removing medical management services from the limit (and the 50 percent coinsurance requirement), and extending direct reimbursement to psychologists and social workers. The proposed two year study seeks to fill the research gaps about mental health costs and use under Medicare Part B, especially in light of recent benefit design changes. This study is particularly timely on the eve of the implementation of the Resource-Based Relative Value Scale for physician reimbursement. This study would provide important baseline information prior to payment reforms under RBRVS. Two Part B databases will be used: one containing all claims for a 5 percent national random sample of beneficiaries (BMAD) and one with all claims for the universe of beneficiaries in ten states which account for nearly one-fourth of all Medicare beneficiaries nationwide. The analytic time period is calendar years 1987 through 1991, with 1987 serving as a baseline period prior to coverage changes. Two analytic tasks are proposed: (1) baseline and trend analysis of Part B mental health spending and use using the national BMAD file; and (2) beneficiary-level analysis of utilization patterns over time using the Ten State Data Base. In addition to examining utilization patterns before and after the limit was raised (and ultimately eliminated), the study will examine the impact of direct reimbursement on costs and utilization. Also, three procedure-specific analyses are proposed on the use of medical management services, partial hospitalization services, and ECT treatments. This study will also project the costs of reducing the coinsurance rate from 50 percent to 20 percent, to achieve parity with medical and surgical services. This study will result in three important products: a comprehensive data book on Medicare and mental health services in the U.S. (1987-1991); an in- depth report on beneficiary level patterns of use in ten states including a discussion of policy implications; and a set of analytic files with a five-year time series of Part B mental health claims that could be used to pursue additional research on Medicare and mental health services under Medicare Part B.