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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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 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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Helping News                                                  August 2010 Issue 25


Coping with the death of a loved one

The death of a loved one can be the most stressful event in a person’s life. A wide array of emotions can be experienced, such as sadness, anger, anxiety, guilt, and despair. Changes in sleep patterns and appetite can occur, as well as physical illness. These are all normal parts of grieving and the feelings can ebb and flow over time. 
There is no "right way" and "wrong way" to grieve. Each person experiences grief in his or her own way, partly based on religious, cultural, social, and personal beliefs and partly because of the relationship with the person who died.

Bereavement has four basic phases 
which typically occur: 

Numbness and shock—usually 
occurs in the beginning and lasts 
a brief period. It is useful in helping
people function through the initially
funeral time period. 

Feeling of separation—when the
feeling of loss or missing the loved 
one starts to occur. 

Disorganization—time period when the bereaved is easily distracted and might have difficulty concentrating or may feel restless. 

Reorganization—toward the end of the bereavement period when the person has begun to adjust to life without the loved one. 

It is very important to seek out people who understand your loss. It may be friends, family, therapists, clergy, or support groups. It takes a long time to complete the grieving process, so you need to be patient to allow yourself the chance to grieve. 

How can I help myself? 

Keep a journal—sometimes it is helpful to write down thoughts and feelings. 
Read books on loss—for some, reading about someone else’s experiences with loss can be very helpful. 

Start with an activity which was relaxing—this can help in the beginning to get back to a normal cycle, and it can provide some stability and familiarity. 

Talk about the person who died, if you want to—even though it may be painful, talking about particular memories can be healing. 
If helpful, go to a support group—many people find groups to be a helpful place to talk about their grief. 

When should you seek help? 

If grief is lasting over a year. 
If there is a major change in weight (either loss or gain). 
If suicidal thoughts are occurring. 
If there are continual difficulties with sleeping. 
If there is prolonged emotional distress. 

Stay connected to your health care providers. You need to remember to take care of yourself. You need to contact a mental health counselor right away if you feel like you are very depressed and not getting better or if you are thinking about harming yourself.

What type of help is available?

Support groups for grieving individuals. Bereavement support groups provide a place to talk about grief, fears, and other feelings which can be there after the death of a loved one. Groups also help people learn from the experiences of others and are very beneficial for children and teenagers. If desired, contact your local hospice or hospital for information about a support group in your area.

Family therapy. "Family" means many things people to many people. It can be people related to you or other people who are very significant in your life. The experience of a loss touches everyone in your family. Family therapists are specially trained to understand the impact of loss on a family and can assist you through your bereavement process.

Books and journals. There are a wide variety of books available for people experiencing loss. Many people who are bereaved find these types of books to be helpful, especially those written by individuals who have experienced a similar loss themselves. Some of the books are mentioned in this brochure; check bookstores for other selections.

Organizations for the bereaved. There are many wonderful organizations started by people who have experienced a loss and who have wanted to help others. Some of them focus on a particular type of death, such as drunk driving. 


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