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Major Provisions in HR 6331 for Beneficiaries with Mental Illness

July 10, 2008

HR 6331 includes a number of critical provisions for Medicare beneficiaries living with serious mental illness, including:

  • Parity for cost sharing for outpatient mental health services under Part B, gradually moving the current discriminatory 50% requirement down to 20% between 2010 and 2014,
  • Statutory authority under the Part D drug benefit for the Centers for Medicare and Medicaid Services (CMS) to ensure broad coverage on prescription drug plan formularies for antipsychotics, antidepressants and anticonvulsants,
  • Removal of the current ban on Part D plans offering coverage for benzodiazepines (a critical tool in treatment for acute mania in bipolar disorder and severe anxiety disorders),
  • Changes to eligibility for the Part D Low-Income Subsidy (LIS) program (also known as "Extra Help") – These reforms include an increase the amount of allowable resources, elimination of barriers to enrollment and the current late enrollment penalty and new exemptions for the value of a life insurance policy and in-kind support and maintenance.  Eligibility for the LIS significantly lowers premiums and cost sharing for drug coverage and exempts beneficiaries from the "doughnut hole" coverage gap.

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