A new Medicare bill for senior SUD care has been introduced to expand coverage for residential treatment options addressing a crucial gap in elder care. Historically, Medicare has covered only hospital or outpatient programs for SUD treatment, leaving a significant gap in access to non-hospital-based residential care. Introduced in both the Senate and House, this new bill seeks to address accessibility roadblocks by expanding Medicare coverage to include residential SUD treatment for seniors.
The proposed Residential Recovery for Seniors Act is designed to provide older adults with access to the entire continuum of care, recognizing the need for comprehensive substance use treatment extends beyond hospital-based services. As the prevalence of SUD among older adults continues to rise due to lack of monitoring over self-administered prescriptions, over prescription, infrequent PCP visits and more, this legislation could be a game-changer for millions of seniors who previously had limited options for community-based recovery.
Key Provisions of the Residential Recovery for Seniors Act:
- Medicare Coverage Expansion: The bill would create a new Medicare benefit under Part A, allowing beneficiaries to access Level 3 residential SUD care. This expansion closes the coverage gap between less intensive outpatient services and the most intensive hospital-based treatments.
- Target Population: The act focuses on older adults, who are at a higher risk for developing SUDs but have historically been overlooked in terms of treatment options. The legislation addresses the unique challenges faced by seniors, including social isolation and increased exposure to psychoactive substances, which contribute to the development of addiction.
- Bipartisan Support and Legislative Momentum: The bill has garnered attention from healthcare advocates and legislators across party lines. Senator Bob Casey’s (D-PA) introduction of the bill in the Senate and Representative Lauren Underwood’s (D-IL-14) matched efforts in the House to signal a strong push for a more comprehensive medicare bill for senior SUD care.
- Industry Perspective: Healthcare providers and insiders have long called for expanded access to residential SUD treatment for Medicare beneficiaries. As underreporting SUD within the Medicare population created a pressing need for broader treatment options, today, experts emphasize providing seniors with access to residential care could significantly improve outcomes and reduce the burden on hospital systems.
Considerations for Providers and States:
- Readiness for Implementation: Providers and state Medicaid agencies should begin preparing for the potential expansion of Medicare coverage to include residential SUD care. This may involve updating billing practices, modifying existing properties, and ultimately ensuring that treatment programs meet the criteria for Medicare reimbursement.
- Policy Implications: The introduction of the bill highlights ongoing efforts to step-up the continuum of care for older adults with SUD. State-level decision makers can expect to consider how this legislation might impact their existing Medicaid programs and how they can more broadly integrate residential SUD care into existing behavioral health strategies in the near future.
- The Future of SUD Care: If passed, the Residential Recovery for Seniors Act could set a precedent for further expansions in Medicare coverage for seniors and all individuals with SUD. Moreover, this change could mark a significant shift in how substance use treatment is delivered and funded in the United States.
Conclusion
The Residential Recovery for Seniors Act presents more options to address the needs of older adults struggling with substance use disorders. By expanding Medicare coverage to include residential care, the proposed legislation has the potential to transform how seniors receive SUD treatment. Healthcare providers, policymakers, and states should stay informed and otherwise prepared for the changes this bill could bring to the landscape of behavioral health care.
For more information and to track the progress of this legislation, click below.
Sources: https://bhbusiness.com/2024/08/07/new-bill-proposes-medicare-coverage-for-residential-sud-care/ https://www.casey.senate.gov/news/releases/casey-introduces-bill-to-expand-care-for-seniors-recovering-from-substance-use-disorders