H.R. 4619: Medicare Mental Health Inpatient Equity Act of 2025

This bill, known as the Medicare Mental Health Inpatient Equity Act of 2025, proposes to change the way Medicare covers inpatient psychiatric hospital services. Currently, there is a 190-day lifetime limit on inpatient psychiatric care covered by Medicare. This means that once a patient has used up these 190 days of coverage, they must pay out of pocket for any additional days they need in a psychiatric hospital.

Key Provisions of the Bill

• Elimination of the 190-Day Limit: The primary goal of the bill is to remove the existing 190-day lifetime limit on inpatient psychiatric hospital services. This change would allow patients to receive additional care beyond the current cap, depending on their individual needs.
• Amendment of the Social Security Act: The bill proposes amendments to Section 1812 of the Social Security Act, which governs Medicare's coverage of inpatient psychiatric services.
• New Effective Date: If the bill is enacted, the changes would apply to services provided on or after January 1, 2027.

Impact on Patients

By eliminating the 190-day limit, patients with severe mental health conditions who exceed the current limit would have the opportunity to access more extended inpatient care without worrying about out-of-pocket costs. This could significantly affect individuals needing long-term psychiatric treatment and provide them with necessary support for their recovery.

Financial Implications

The bill may have financial implications for the Medicare system, as extending coverage could lead to increased costs under the program. However, supporters of the bill might argue that improved mental health care could lead to better long-term health outcomes and potentially reduce costs related to emergency care or less effective short-term solutions.

Relevant Stakeholders

This bill affects various stakeholders, including patients with mental health issues, healthcare providers, and policymakers concerned about mental health care access and funding.

Relevant Companies

• None found