June's Advocacy Issue Is PARITY. Here you will find all you need to know about Mental Health Insurance Parity!
SPECIAL JUNE ADVOCACY EVENT ON PARITY: There is a special congressional hearing on parity on Tuesday, June 26, 2012 @ 7:30 with Congressman Chris Van Hollen, located at Village of Friendship Heights Village Center, 443 South Park Avenue, Chevy Chase, Maryland. We are collecting parity concerns to be able to share at this event, so please contact Christine Merola at cmerola@namibaltimore.org to share your story or if you have any questions!
History of Parity-
Historically, the majority of private insurance companies have limited the mental health benefits of those they insured. Private insurance companies routinely have assigned separate deductibles to mental health treatment, reimbursed a smaller percentage of total treatment costs, or assigned higher co-pays for mental health care. Some insurers simply refused to cover mental illnesses at all. In an effort to end this discrimination-
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (P.L. 110-343) was signed into law on October 3, 2008.
The act officially went into act January 1, 2010, although it was passed in 2008.
What Parity does-
Requires health insurance plans to provide coverage for mental health and addictions treatment that is equitable to the coverage they offer for any other type of illness.
What Parity does not do-
Federal parity does not require plans to offer coverage for mental health or substance use disorders, but for insurance companies that do cover mental health and substance abuse, coverage must be equal.
The act imposes no requirement as to what conditions must be covered. But whatever is covered must be at parity with other medical coverage.
Parity will not get you good mental health coverage. Comprehensive parity requires equivalent coverage, not necessarily “good” coverage. If your health insurance plan is very limited, then your mental health coverage will be similarly limited.
Conditions-
Federal parity law allows health insurance plans to define which mental health and substance use disorders, if any, they will cover.
Phobias and other psychological conditions must be treated exactly the same as broken arms or other physical ailments. Deductibles, copays, and other out of pocket expenses must be equal to what you pay for your other medical insurance, and your right to treatment cannot be limited.
In addition, restrictions on number of visits, frequency of treatments, and all other services provided must be comparable.
Federal parity law does not require that plans provide out-of-network coverage. However, if out-of-network coverage is provided for medical/surgical benefits, the plan must provide equivalent out-of-network coverage for mental health and substance use disorders.
Federal law does not preempt stronger state parity provisions; state-regulated large group plans must comply with more comprehensive state parity requirements. For example, if state law requires plans to cover mental health conditions, then they must do so, even though coverage is optional under federal parity.
How do I know if my plan is covered by a parity law?
Whether or not your plan is covered by a state or federal parity law depends on the kind of health plan you are enrolled in and event its size. If you are unsure about what type of plan you have, ask your insurance carrier or agent, your plan administrator, or your human resources department.
Loop holes-
Group health insurance plans that cover 50 or less employees are exempt from the parity.
Federal parity law allows health plans to seek an exemption from parity requirements for a period of one year if they can document that compliance with the law resulted in costs going up more than 2% in the first year or 1% thereafter.
Medicare is a federal health plan that does not currently provide parity coverage for mental health and substance use conditions.
Many states exclude certain mental health and/or substance use conditions from their parity law or restrict their parity law to a state-defined list of “serious mental illnesses” or biologically based mental illnesses.”
To find out what conditions your state law covers, see State Mental Health Parity Laws at www.nami.org/parity
Advocacy- MAKE A DIFFERENCE THIS MONTH! SPECIAL JUNE ADVOCACY EVENT ABOUT PARITY!
For parity to achieve its intended goals, it is important for mental health advocates to work closely with their state insurance divisions.
Together, advocates can promote education of and compliance with parity requirements, monitor results, facilitate handling of consumer complaints, enhance transparency and accountability, and expand needed consumer protections.
If your parity law isn’t helping people the way you expected, you can advocate for better regulations, enforcement, or legislation to strengthen your laws.
On Tuesday, June 26, 2012 @ 7:30 a congressional field hearing on mental health parity will be held with Congressman Chris Van Hollen. This event is located at Village of Friendship Heights Village Center, 443 South Park Avenue, Chevy Chase, Maryland. If you would like more information on this event and/or have a personal insurance discrimination story to share please contact- Christine Merola @ www.nami.org/sites/namimetrobaltimore
Capitol Hill Watch: Federal Legislation Focused on Mental Health and Schools
Three federal bills that support school-based mental health services and supports have recently been introduced in Congress. Below is a summary of the three bills:
Mental Health in Schools Act (H.R. 751):
This bill was introduced in February 2011 and would provide much needed federal funding to create partnerships between schools, community mental health services and supports and other child-serving systems to help ensure that children and youth living with mental illness are identified early and linked with effective services.
This legislation would do the following:
Provide expanded federal funding for grant programs that provide access to comprehensive school-based mental health services and supports
Provide comprehensive staff development for school and community child-serving systems to ensure that students are connected with effective mental health services and supports and that positive behavioral interventions and supports (PBIS) programs are implemented in schools
Provide comprehensive training for children with mental illness, their families and community members about the importance of early identification of mental illness, strategies to connect students with school and community-based services and supports and strategies that promote a schoolwide positive environment
Keeping All Students Safe Act (H.R. 1381):
This bill was introduced in April 2011 and is designed to prevent and reduce the inappropriate use of restraint and seclusion in our nation's schools by establishing minimum safety standards similar to those already in place in hospitals and other community-based facilities.
Prevent and reduce the inappropriate use of restraint and seclusion by establishing minimum federal safety standards that schools must follow
Require states to develop policies and procedures and monitoring and enforcement systems to meet the federal standards and to help keep children and school staff safe in our nation's schools
Encourage and create funding incentives for states to provide training and support to school staff to reduce and eliminate the use of restraint and seclusion in schools and create a more positive school environment
Increase transparency, oversight, enforcement and reporting requirements to prevent abuse and reduce and eliminate the use of restraint and seclusion in schools
Achievement through Prevention Act (S. 541):
This bill would provide federal support for the expanded use of PBIS and early intervening services in schools to improve student academic achievement, create a more positive school climate and reduce student disciplinary referrals.
UPDATE: Ruxton House: Wait and See
According to a June 26 article in the Baltimore Sun, despite weeks of meetings and discussions with Sheppard Pratt Health System officials, Ruxton residents still oppose the mental health facility slated to open in their neighborhood this fall.
The article further states that until the hospital applies for a license to run the group home, residents say they are in wait-and-see mode.
Ruxton residents are trying to thwart Sheppard Pratt Medical Systems' proposal for a high-end mental health rehabilitation center in their neighborhood. Members of the Ruxton community have formed a 501(c)(3) to fight this housing, have launched a sophisticated campaign and are working to organize other community associations to join their efforts to prevent individuals who have mental illnesses from living in their community of choice.
Sheppard Pratt's proposal is to convert a six-bedroom house on Labelle Avenue into a facility for patients undergoing treatment for issues such as depression and anxiety. Sheppard Pratt has completed the purchase of the home and is now the owner of it.
Advocates for the Sheppard Pratt facility are being urged to do the following:
3. Contact Bonnie Katz bkatz@sheppardpratt.org or Steve Sharfstein ssharfstein@sheppardpratt.org if you know individuals living in the aforementioned communities who are willing to speak in support of the right of individuals with mental illness to live in the community of their choosing or otherwise assist in our collective response.
Oppose Block Granting Medicaid
Advocates are being urged to contact their House member and Senators to oppose a Medicaid block grant proposal. Medicaid is the most important source of public mental health funding, paying for nearly half of all services, and the budget passed at the end of last week in the House would result in major reductions in future federal spending on Medicaid and convert the program from a federal entitlement to a block grant to the states.
All House and Senate offices can be reached at 1-888-876-6242 or 202-224-3121 or you may send an e-mail message to your congressional member here.
More information and analyses of the Medicaid block grant proposal in the draft House budget resolution is available at:
The Governor's funding cuts for mental health services have been restored through the Governor's supplemental budget for mental health. The Governor's first supplemental budget came out on Friday, April 1st, and it included $5 million general funds and $5 million federal funds to enhance rates for Mental Health Community Providers.
Additionally, the supplemental includes an additional $25 million for the Mental Hygiene Administration.
Meanwhile, we await word from the budget conference committee about the legislative cuts.
Advocacy Day 2011
Advocacy Day in Annapolis was held on Tuesday, February 8, 2011 and NAMI Metropolitan Baltimore was out in full force. We met with legislators to advocate for mental health services and attended the Rally for Mental Health Services at Lawyers Mall. Here, our very own Chicquita Crawford, family member, speaks at the rally:
Dime A Drink Tax: You can still contact your legislators to show your support of the Dime A Drink Tax. Click here for more information.
Supportive Housing Legislation: Urge Senators to press for action on supportive housing legislation. Click here for more information.
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Health Insurance For Families With Young Adults
Click here for more information on the Health Care Reform Act and how it will affect you.
Some health insurers are allowing young adults who are currently on their parents' health insurance plan to remain on the policy before a new federal law takes effect on September 23, 2010. The young adults may remain on their parents' plan if the policy is fully insured and subject to State regulation.
The insurers are as follows:
CareFirst:
CareFirst of Maryland, Inc.
Group Hospitalization and Medical Service, Inc.
CareFirst BlueChoice, Inc.
Aetna
Aetna Life Insurance Company
Aetna Health, Inc.
Cigna
Connecticut General Life Ins. Co.
Cigna Healthcare Mid., Inc.
Kaiser
Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
Metropolitan Baltimore
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