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 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. 
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 
2.Inpatient, out-of-network 
3.Outpatient, in-network 
4.Outpatient, out-of-network 
5.Emergency care 
6.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%  
 
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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. 






 
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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 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. 
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 
2.Inpatient, out-of-network 
3.Outpatient, in-network 
4.Outpatient, out-of-network 
5.Emergency care 
6.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%  
 
Previous Newsletter

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More information coming...   

    
Helping News                                                  April 2010 Issue 21
 

Depression and diet: Make healthy choices
By Gabrielle J. Melin, M.D.  Oct. 27, 2009






 
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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 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. 
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 
2.Inpatient, out-of-network 
3.Outpatient, in-network 
4.Outpatient, out-of-network 
5.Emergency care 
6.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%  
 
Previous Newsletter

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More information coming...   

    
Helping News                                                  September 2010 Issue 26
 


More college students are afflicted with severe mental illness


The number of college students who are afflicted with a serious mental illness is rising, according to data presented Thursday at the annual meeting of the American Psychological Assn. in San Diego
 
The findings came from an analysis of 3,265 college students who used campus counseling services between September 1997 and August 2009. The students were screened for mental disorders, suicidal thoughts and self-injurious behavior.
 
In 1998, 93% of the students seeking counseling were diagnosed with one mental disorder, compared to 96% of students in 2009. The percentage of students with moderate to severe depression rose from 34% to 41% while the number of students on psychiatric medications increased from 11% to 24%.
 
However, the number of students who said they had thought about suicide within two weeks of counseling fell from 26% in 1998 to 11% in 2009 -- a figure that could reflect improvements in suicide prevention and counseling outreach on college campuses.

Efforts have been made in recent 
years to improve the lives of college 
students who have mental illness.
 
". . .our findings may suggest that 
students with severe emotional 
stress are getting better education, 
outreach and support during 
childhood that makes them 
more likely to attend college 
than in the past," the lead author 
of the study, John Guthman of 
Hofstra University, said in a 
news release.
 
Several programs are available to assist students with mental illness, including Half of Us and Active Minds. In addition, the Jed Foundation recently launched a program for high school juniors who have a mental illness to help them select a college that will accommodate students with mental health needs. The program, called the Transition Year, provides information on what students and parents can do to prepare for the college transition.
 
-- Shari Roan / Los Angeles Times
 








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