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 October 2010 Issue 27
Antipsychotics May Be Linked to Blood Clots
Study Shows Increased Risk of Developing Deep Vein Blood Clot or Pulmonary Embolism
By Salynn Boyles
Reviewed by Laura J. Martin, MD Sept. 22, 2010 --
Taking antipsychotic drugs, especially newer “atypical” antipsychotics, appears to increase a user’s risk for developing potentially life-threatening blood clots.
In a new study from the U.K., antipsychotic drug use was associated with about a 30% increase in risk for deep vein blood clots or pulmonary embolism.
The risk was highest for new users of the drugs and for patients prescribed atypical antipsychotics, which include Seroquel (quetiapine), Risperdal (risperidone), and Zyprexa (olanzapine).
Compared to patients who did not take
antipsychotic drugs, users of atypical
antipsychotics were 73% more likely to
develop the dangerous blood clots. Seroquel
use was associated with a nearly threefold
adjusted increase in risk among the study
population.
The risk to individual patients remained quite small and the findings need to be confirmed by other researchers, study researcher Julia Hippisley-Cox, MD, of the University of Nottingham, tells WebMD.
The study is published in BMJ Online First.
“I would consider this as an important, but modest increase in risk,” she says, adding that the findings add “to the accumulating evidence of adverse health events associated with antipsychotics.”
Antipsychotics Widely Used to Treat Dementia
Antipsychotic drugs are widely prescribed for psychosis and other psychiatric conditions and for non-psychiatric ailments, including nausea and vertigo.
They are among the most widely used drug treatments for agitation in people with Alzheimer’s disease and other forms of dementia, geriatric medicine specialist Rosa Liperoti, MD, MPH, tells WebMD.
This remains the case, even though the FDA has warned their use may be associated with an increased risk of death among the elderly with dementia-related psychosis.
The warning includes both atypical antidepressants and conventional antidepressants like Thorazine (Chlorpromazine) and Haldol (Haloperidol).
“These drugs are not approved for this use, but they are frequently used,” she says. “I think it is clear these drugs are prescribed too often for these off-label uses.”
New Users Had Twofold Risk Increase
In the newly published study, researchers analyzed data from a nationwide medical registry that included 11 million patients attending more than 500 general practices throughout the U.K.
Just over 25,500 people were treated for a deep vein blood clot or pulmonary embolism between 1996 and 2007. Close to 90,000 registry members who were not treated for blood clots during this period were also included in the analysis.
The study revealed that:
Use of antipsychotic drugs during the previous two years was associated with a 32% increase in blood clot risk.
Use of antipsychotic drugs over the previous three months was associated with a 56% increase in risk
Starting antipsychotic drugs within the past three months was associated with a twofold increase in risk.
Risk to Individual Patients Is Small
But the treatment-associated risk to individual patients was small, representing about four additional deep vein blood clots or pulmonary embolisms among 10,000 patients treated with the drugs for a year.
In an editorial published with the study, Liperoti and colleague Giovanni Gambassi, MD, wrote that even though the risk is small, doctors should consider this risk before prescribing antipsychotic drugs to patients with a higher than average risk for developing potentially life-threatening blood clots.
“In clinical practice, we need to be able to identify the best candidates for antipsychotic treatment ...and those who may be more susceptible to developing side effects as a result of individual vascular risk factors possibly interacting with antipsychotics.”
More information coming...
