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National Alliance on Mental Illness
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Health Care Reform Law Implementation Begins; Initial Wave of Insurance Market Reforms Take Effect

by Andrew Sperling, J.D., NAMI director of legislative affairs

On Sept. 23, the first set of consumer and patient protections in the Patient Protection and Affordable Care Act (federal health care reform) went into effect. These protections include:

  • A ban on denials or limits on coverage or benefits for children under age 19 that have a pre-existing condition. This will benefit children living with mental illness who are covered by their parent's plan.
  • A prohibition on lifetime dollar limits on most health insurance benefits, including mental health benefits, in all policies issued or renewed after September 23, 2010. This will help protect enrollees, particularly those who experience multiple hospitalizations or have chronic and intensive mental health care needs.
  • Extension of dependent coverage for adult children up to age 26 in all individual and group health insurance policies. This will make it possible for young adults at a time when many first experience mental illness to be covered under a parent's plan.
  • A ban on cancellation (also known as "rescissions") of insurance coverage due to honest mistakes or omissions in insurance applications. Insurance companies will have to prove fraud to justify canceling insurance policies.
  • New rights to appeal adverse insurance decisions, such as denials of care. For most plans, plan holders must be provided a copy of the rationale for any denial of coverage and, importantly, there will now be an independent external appeals process in all states and for most plans.
  • New requirements for health plans to offer coverage of certain preventive services with no cost sharing or deductible. These include many services associated with primary medical care that many people living with serious mental illness struggle to access such as routine blood pressure, cholesterol screening and diabetes monitoring as well as alcohol abuse and tobacco cessation counseling. In addition, depression screening for both adolescents and adults are included in the list of preventive services validated by the U.S. Preventive Services Task Force that must be offered by health plans at no charge.

To find out more about these and other insurance reforms, visit www.healthcare.gov.

The federal health reform law contains many other provisions that will impact health and mental health care. These changes will be implemented over the course of the next few years. For a list and timetable of these changes, go to http://healthreform.kff.org/timeline.aspx.

NAMI Comments on Draft Regulations

In recent months, various federal agencies have been publishing draft and interim final regulations implementing the health care reform law. NAMI has been submitting comments on each of these rules including preventive services, external appeals and interim high risk pools for individuals with pre-existing conditions.

You can view NAMI's comments on these rules and get information on health care reform at NAMI's special website on health care reform, www.nami.org/healthcare.

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