Helping News April 2010 Issue 21
Federal Parity Law Now in Effect - Is It Working For You?
For many group health plans, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act went into effect on January 1, 2010. The new law requires most group health plans to cover treatment for mental illness and substance use disorders on the same terms and conditions as medical conditions such as diabetes, heart disease, cancer and asthma. Specifically the new law bars health plans from imposing durational treatment limits (caps on inpatient days or outpatient visits) or financial limitations (higher cost sharing, deductibles or out of pocket limits) that do not also apply to medical-surgical coverage.
The effective date of the new law is actually the beginning of the first new plan year after October 3, 2009. The new law applies to all group health plans sponsored by employers with 50 or more workers.
Is Your Health Plan in Compliance With Parity?
This information is critical to informing policymakers in the U.S. Congress and the Obama Administration on additional steps that may need to be taken to strengthen the law and ensure adequate enforcement. In addition, it is critical for NAMI to demonstrate to the larger public that parity is making a real difference in improving coverage of mental illness treatment and expanding access to critical medical services for children and adults living with mental illness.
Share Your Story- Individuals and families are strongly encouraged to share their personal experiences with parity implementation - both positive and negative. Are you or your experiencing any of the following?
•
Is your health plan still imposing an arbitrary limit on covered inpatient days or outpatient visits for behavioral health coverage?
Is your health plan still imposing an arbitrary limit on covered inpatient days or outpatient visits for behavioral health coverage? •Is your group health plan applying a separate lower deductible or higher cost sharing for outpatient mental health services?
Is your group health plan applying a separate lower deductible or higher cost sharing for outpatient mental health services? •Have you noticed improved coverage for mental illness treatment in your group health plan in 2010, e.g. lower cost sharing, a lower deductible or elimination of a treatment limitation such as a cap on outpatient visits? Is so, the new parity law is already making and difference and we want to hear from you.
Have you noticed improved coverage for mental illness treatment in your group health plan in 2010, e.g. lower cost sharing, a lower deductible or elimination of a treatment limitation such as a cap on outpatient visits? Is so, the new parity law is already making and difference and we want to hear from you. •Is your group health plan still using a separate deductible that applies only the plan's behavioral health benefit? If so, they are likely doing so in violation of the new parity law.
Is your group health plan still using a separate deductible that applies only the plan's behavioral health benefit? If so, they are likely doing so in violation of the new parity law. Agencies Issue Interim Final Parity Regulations
On February 2, the Departments of Health and Human Services, Education, Labor and Treasury released interim final rules providing guidance on how the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
At first glance, the regulations appear to be a huge victory for consumers and families. The regulations adopt a robust standard for medical-surgical benefits that mental health benefits must be comparable to - specifically, "predominant" and "substantially all" of medical-surgical coverage. In addition, the regulations include comprehensive definitions of treatment limits and financial limitations for which parity is required.
Finally, and most importantly, the regulations provide new standards with respect to equitable coverage for "non-quantitative" treatment limits, which are defined in the regulations as medical management, drug formulary design, step therapy, "fail first" policies and exclusions from coverage based on failure to complete a course of treatment. This means that the standards for equitable coverage will apply to discriminatory application of medical management techniques as applied to mental illness treatment.
It is important to note that these interim final rules are not the last word on implementation of the new parity law. A separate guidance is expected soon from the Centers for Medicare and Medicaid Services to states on how the law will apply to Medicare managed care plans. In addition additional guidance is expected later on the law's allowance for a cost increase exemption.
Effective Date of the Regulations: This IFR goes into effect on April 5 and will apply to group health plans with plan years starting on July 1 or later. Those plans that were charged with compliance for a plan year that began on January 1, 2010 will be given a good faith exception for compliance with the regulations until July 1.
Scope of Service: The IFR divides benefits into six classifications:
1.Inpatient, in-network
Inpatient, in-network 2.Inpatient, out-of-network
Inpatient, out-of-network 3.Outpatient, in-network
Outpatient, in-network 4.Outpatient, out-of-network
Outpatient, out-of-network 5.Emergency care
Emergency care 6.Prescription drugs
Prescription drugs Within each classification, if a plan provides MH/SU benefits, those benefits must be provided at parity with the medical/surgical benefits provided in that classification. In addition, the Departments are encouraging public comments on whether and to what extent the Parity Act addresses scope of services or continuum of care provided by insurance plans (information about how to submit public comments is included in the IFR).
Cumulative Financial Requirements: The IFR prohibits plans from instituting separate deductibles, copayments, and out-of-pocket limits for MH/SU and medical/surgical benefits. Any deductibles, copayments, and out-of-pocket limits required by the plan must be integrated and cumulative for all services.
NAMI will be submitting comments on the Interim Final Rule and will be urging NAMI state and local affiliate organizations to do the same in advance of the May 3 comment deadline.
Results of the previous web-poll: Reporting the amount of actual sleep vs ideal amount persons receive
The amount of sleep you get affects your well-being. On average how much sleep do you get each night?
9 hours or more(0)
8 hours 9%
7 hours 23%
6 hours 45%
Less than 6 hours 23%
What do you think is the ideal amount of sleep each night?
9 hours or more(0)
8 hours 18%
7 hours 36%
6 hours 41%
6 hours or less 5%
More information coming...
Helping News May 2010 Issue 22
Depression and diet: Make healthy choices
By Gabrielle J. Melin, M.D. Oct. 27, 2009
It makes sense that if the fuel we are providing for our body,
including our brains, is healthy, that our bodies will function more efficiently. We all know that diets higher in fiber, as well as low in saturated fats, contribute to better health overall.
We have talked about the link between depression and other medical illnesses many times. For instance, depression and heart disease are linked. Thyroid disease is another medical condition that can cause or contribute to depression. Your diet may be another link.
Eating a Mediterranean diet may
lower the risk of depression by
almost one-third, according to
some research. The
Mediterranean diet includes lots
of fruits and vegetables, as well
as whole grains and healthy fats
and oils. This doesn't mean that
diet alone is an alternative way
to treat depression. But, it can't
hurt to make healthier food
choices each day. As always,
please talk with your health care
provider about specific
treatment options for depression,
including your diet choices.
More information coming...
Helping News April 2010 Issue 21
Federal Parity Law Now in Effect - Is It Working For You?
For many group health plans, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act went into effect on January 1, 2010. The new law requires most group health plans to cover treatment for mental illness and substance use disorders on the same terms and conditions as medical conditions such as diabetes, heart disease, cancer and asthma. Specifically the new law bars health plans from imposing durational treatment limits (caps on inpatient days or outpatient visits) or financial limitations (higher cost sharing, deductibles or out of pocket limits) that do not also apply to medical-surgical coverage.
The effective date of the new law is actually the beginning of the first new plan year after October 3, 2009. The new law applies to all group health plans sponsored by employers with 50 or more workers.
Is Your Health Plan in Compliance With Parity?
This information is critical to informing policymakers in the U.S. Congress and the Obama Administration on additional steps that may need to be taken to strengthen the law and ensure adequate enforcement. In addition, it is critical for NAMI to demonstrate to the larger public that parity is making a real difference in improving coverage of mental illness treatment and expanding access to critical medical services for children and adults living with mental illness.
Share Your Story- Individuals and families are strongly encouraged to share their personal experiences with parity implementation - both positive and negative. Are you or your experiencing any of the following?
•Is your health plan still imposing an arbitrary limit on covered inpatient days or outpatient visits for behavioral health coverage?
Is your health plan still imposing an arbitrary limit on covered inpatient days or outpatient visits for behavioral health coverage? •Is your group health plan applying a separate lower deductible or higher cost sharing for outpatient mental health services?
Is your group health plan applying a separate lower deductible or higher cost sharing for outpatient mental health services? •Have you noticed improved coverage for mental illness treatment in your group health plan in 2010, e.g. lower cost sharing, a lower deductible or elimination of a treatment limitation such as a cap on outpatient visits? Is so, the new parity law is already making and difference and we want to hear from you.
Have you noticed improved coverage for mental illness treatment in your group health plan in 2010, e.g. lower cost sharing, a lower deductible or elimination of a treatment limitation such as a cap on outpatient visits? Is so, the new parity law is already making and difference and we want to hear from you. •Is your group health plan still using a separate deductible that applies only the plan's behavioral health benefit? If so, they are likely doing so in violation of the new parity law.
Is your group health plan still using a separate deductible that applies only the plan's behavioral health benefit? If so, they are likely doing so in violation of the new parity law. Agencies Issue Interim Final Parity Regulations
On February 2, the Departments of Health and Human Services, Education, Labor and Treasury released interim final rules providing guidance on how the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
At first glance, the regulations appear to be a huge victory for consumers and families. The regulations adopt a robust standard for medical-surgical benefits that mental health benefits must be comparable to - specifically, "predominant" and "substantially all" of medical-surgical coverage. In addition, the regulations include comprehensive definitions of treatment limits and financial limitations for which parity is required.
Finally, and most importantly, the regulations provide new standards with respect to equitable coverage for "non-quantitative" treatment limits, which are defined in the regulations as medical management, drug formulary design, step therapy, "fail first" policies and exclusions from coverage based on failure to complete a course of treatment. This means that the standards for equitable coverage will apply to discriminatory application of medical management techniques as applied to mental illness treatment.
It is important to note that these interim final rules are not the last word on implementation of the new parity law. A separate guidance is expected soon from the Centers for Medicare and Medicaid Services to states on how the law will apply to Medicare managed care plans. In addition additional guidance is expected later on the law's allowance for a cost increase exemption.
Effective Date of the Regulations: This IFR goes into effect on April 5 and will apply to group health plans with plan years starting on July 1 or later. Those plans that were charged with compliance for a plan year that began on January 1, 2010 will be given a good faith exception for compliance with the regulations until July 1.
Scope of Service: The IFR divides benefits into six classifications:
1.Inpatient, in-network
Inpatient, in-network 2.Inpatient, out-of-network
Inpatient, out-of-network 3.Outpatient, in-network
Outpatient, in-network 4.Outpatient, out-of-network
Outpatient, out-of-network 5.Emergency care
Emergency care 6.Prescription drugs
Prescription drugs Within each classification, if a plan provides MH/SU benefits, those benefits must be provided at parity with the medical/surgical benefits provided in that classification. In addition, the Departments are encouraging public comments on whether and to what extent the Parity Act addresses scope of services or continuum of care provided by insurance plans (information about how to submit public comments is included in the IFR).
Cumulative Financial Requirements: The IFR prohibits plans from instituting separate deductibles, copayments, and out-of-pocket limits for MH/SU and medical/surgical benefits. Any deductibles, copayments, and out-of-pocket limits required by the plan must be integrated and cumulative for all services.
NAMI will be submitting comments on the Interim Final Rule and will be urging NAMI state and local affiliate organizations to do the same in advance of the May 3 comment deadline.
Results of the previous web-poll: Reporting the amount of actual sleep vs ideal amount persons receive
The amount of sleep you get affects your well-being. On average how much sleep do you get each night?
9 hours or more(0)
8 hours 9%
7 hours 23%
6 hours 45%
Less than 6 hours 23%
What do you think is the ideal amount of sleep each night?
9 hours or more(0)
8 hours 18%
7 hours 36%
6 hours 41%
6 hours or less 5%
More information coming...
Helping News April 2010 Issue 21
Depression and diet: Make healthy choices
By Gabrielle J. Melin, M.D. Oct. 27, 2009
More information coming...
Helping News April 2010 Issue 21
Federal Parity Law Now in Effect - Is It Working For You?
For many group health plans, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act went into effect on January 1, 2010. The new law requires most group health plans to cover treatment for mental illness and substance use disorders on the same terms and conditions as medical conditions such as diabetes, heart disease, cancer and asthma. Specifically the new law bars health plans from imposing durational treatment limits (caps on inpatient days or outpatient visits) or financial limitations (higher cost sharing, deductibles or out of pocket limits) that do not also apply to medical-surgical coverage.
The effective date of the new law is actually the beginning of the first new plan year after October 3, 2009. The new law applies to all group health plans sponsored by employers with 50 or more workers.
Is Your Health Plan in Compliance With Parity?
This information is critical to informing policymakers in the U.S. Congress and the Obama Administration on additional steps that may need to be taken to strengthen the law and ensure adequate enforcement. In addition, it is critical for NAMI to demonstrate to the larger public that parity is making a real difference in improving coverage of mental illness treatment and expanding access to critical medical services for children and adults living with mental illness.
Share Your Story- Individuals and families are strongly encouraged to share their personal experiences with parity implementation - both positive and negative. Are you or your experiencing any of the following?
•Is your health plan still imposing an arbitrary limit on covered inpatient days or outpatient visits for behavioral health coverage?
Is your health plan still imposing an arbitrary limit on covered inpatient days or outpatient visits for behavioral health coverage? •Is your group health plan applying a separate lower deductible or higher cost sharing for outpatient mental health services?
Is your group health plan applying a separate lower deductible or higher cost sharing for outpatient mental health services? •Have you noticed improved coverage for mental illness treatment in your group health plan in 2010, e.g. lower cost sharing, a lower deductible or elimination of a treatment limitation such as a cap on outpatient visits? Is so, the new parity law is already making and difference and we want to hear from you.
Have you noticed improved coverage for mental illness treatment in your group health plan in 2010, e.g. lower cost sharing, a lower deductible or elimination of a treatment limitation such as a cap on outpatient visits? Is so, the new parity law is already making and difference and we want to hear from you. •Is your group health plan still using a separate deductible that applies only the plan's behavioral health benefit? If so, they are likely doing so in violation of the new parity law.
Is your group health plan still using a separate deductible that applies only the plan's behavioral health benefit? If so, they are likely doing so in violation of the new parity law. Agencies Issue Interim Final Parity Regulations
On February 2, the Departments of Health and Human Services, Education, Labor and Treasury released interim final rules providing guidance on how the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
At first glance, the regulations appear to be a huge victory for consumers and families. The regulations adopt a robust standard for medical-surgical benefits that mental health benefits must be comparable to - specifically, "predominant" and "substantially all" of medical-surgical coverage. In addition, the regulations include comprehensive definitions of treatment limits and financial limitations for which parity is required.
Finally, and most importantly, the regulations provide new standards with respect to equitable coverage for "non-quantitative" treatment limits, which are defined in the regulations as medical management, drug formulary design, step therapy, "fail first" policies and exclusions from coverage based on failure to complete a course of treatment. This means that the standards for equitable coverage will apply to discriminatory application of medical management techniques as applied to mental illness treatment.
It is important to note that these interim final rules are not the last word on implementation of the new parity law. A separate guidance is expected soon from the Centers for Medicare and Medicaid Services to states on how the law will apply to Medicare managed care plans. In addition additional guidance is expected later on the law's allowance for a cost increase exemption.
Effective Date of the Regulations: This IFR goes into effect on April 5 and will apply to group health plans with plan years starting on July 1 or later. Those plans that were charged with compliance for a plan year that began on January 1, 2010 will be given a good faith exception for compliance with the regulations until July 1.
Scope of Service: The IFR divides benefits into six classifications:
1.Inpatient, in-network
Inpatient, in-network 2.Inpatient, out-of-network
Inpatient, out-of-network 3.Outpatient, in-network
Outpatient, in-network 4.Outpatient, out-of-network
Outpatient, out-of-network 5.Emergency care
Emergency care 6.Prescription drugs
Prescription drugs Within each classification, if a plan provides MH/SU benefits, those benefits must be provided at parity with the medical/surgical benefits provided in that classification. In addition, the Departments are encouraging public comments on whether and to what extent the Parity Act addresses scope of services or continuum of care provided by insurance plans (information about how to submit public comments is included in the IFR).
Cumulative Financial Requirements: The IFR prohibits plans from instituting separate deductibles, copayments, and out-of-pocket limits for MH/SU and medical/surgical benefits. Any deductibles, copayments, and out-of-pocket limits required by the plan must be integrated and cumulative for all services.
NAMI will be submitting comments on the Interim Final Rule and will be urging NAMI state and local affiliate organizations to do the same in advance of the May 3 comment deadline.
Results of the previous web-poll: Reporting the amount of actual sleep vs ideal amount persons receive
The amount of sleep you get affects your well-being. On average how much sleep do you get each night?
9 hours or more(0)
8 hours 9%
7 hours 23%
6 hours 45%
Less than 6 hours 23%
What do you think is the ideal amount of sleep each night?
9 hours or more(0)
8 hours 18%
7 hours 36%
6 hours 41%
6 hours or less 5%
More information coming...
Helping News May 2010 Issue 22
Why some kids really do better..?
March, 2010 by Kirsten Whittaker
A fascinating Australian study looked at the birthdays of Australian Football League (AFL) players and found that many were born in the first months of the year and fewer were born in the later months of the year. The research appears in a Springer book called Analyzing Seasonal Health Data, written by study author Dr. Adrian Barnett and professor Annette Dobson.
In the study, the researchers found that 33% more AFL players than expected had birthdays in January, while 25% fewer had birthdays at the end of the year, in December.
These findings are similar to other research that found there was an association between being born near the start of the school year and a better chance of growing up to be a pro football, volleyball, basketball or ice hockey player.
Interesting that, Wayne Gretzky, Kelly Hrudey and Bobby Hull are all January babies.
The Australian school year starts in January, and according to Barnett, a senior research fellow at the Institute of Health and Biomedical Innovation at the Queensland University of Technology, "Children who are taller have an obvious advantage when playing [Australian rules football]. If you were born in January, you have almost 12 months' growth ahead of your classmates born late in the year, so whether you were born on December 31st or January 1st could have a huge effect on your life,"
Strange to think that two children, born only a day apart, could experience things so differently. One will bear the disadvantage of being the youngest and smallest in the year, while the one born on January 1st will have the benefits of being bigger and stronger earlier than peers.
The Australian research results mirror other work that links being born near the start of the school year and the chances of becoming a professional in either football, volleyball, basketball or ice hockey.
The studies have found that those born at the start of the year do better academically while also having more confidence. Smaller kids miss out, perhaps getting discouraged by playing with those in the same grade who are physically bigger and stronger. Missing out on sports and the exercise that comes with it has consequences not only on their potential athletic careers, but also on their future health as well.
Organized sports have no shortage of cheerleaders, and there are certainly
lots of benefits to being part of a team. Just be sure that your child is both
emotionally and physically ready to participate - pushing a sport too early
is frustrating (and pointless) for everyone.
Sometimes being pushed can turn a child off from sports for good. It's really not until the age of 6 or 7 (usually) that most children have the physical skills and attention span to listen, take turns and understand the rules of a game.
The findings of the Australian research also suggest that children who have potential to excel in sports might be missed because they have to compete with more physically advanced peers.
Understanding the system that's a part of organized sports and the evaluation of potential that favors children born in the early months of any year in sports like hockey, soccer and baseball is key.
Unless a child has exceptional talent at an early age, they won't stand out to coaches as readily and the mechanisms for second chances in a year or two simply don't exist.
More information coming...
