• Q6 asks if nonquantitative treatment limits (NQTL) are analyzed as quantitative treatment limits, mathematically. The response is very clear that there are no mathematical rules for analyzing NQTLs, but the response does not specify how the NQTLs are analyzed.
• The response to Q8 clarifies that retiree-only plans (such as the Maryland State Employee Retiree Plan) are NOT subject to federal parity regulations. The response also states that if a non-federal government plan wishes to opt-out it must take certain administrative steps, such as sending a notice to members.
• Also of note is USDOL states they are committed to working worth stakeholders including state regulators, plan issuers, providers, and beneficiaries to promote compliance with MHPAEA.

The collaborative is open only to organizations in 8 states, but you are welcome to share the materials and knowledge you gather from the collaborative with your members. Some opportunities will be open to individuals, including the first webinar in the series May 15th, 1:30-2:30 entitled, Understanding Basic Insurance Coverage Concepts. Registration is open for this webinar now. 

If you are interested in joining the Collaborative, please email Adrienne Ellis at aellis@mhamd.org with the name of the organization you represent and a contact email.

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Witnesses at the forum included:

• Ashley Bilkie, Michigan resident suffering from an eating disorder (her testimony was read by Kathleen MacDonald with the Eating Disorders Coalition)
• Mark Reinstein, Michigan Partners for Parity
• Kara Freeman, Oakland County Community Mental Health Authority

Rep. Kennedy opened and closed the event, calling on advocates to make parity a reality and stressed that will only happen if advocates fight for it. Michigan is one of 7 states without a parity law, and the Michigan legislature recently passed a parity bill that applies only to coverage for autism spectrum disorders.

The next Parity Field Hearing will be  in the DC Metro area,  June 26th, 7:30 p.m. at the Friendship Heights Community Center. For more information contact Adrienne Ellis at aellis@mhamd.org or check back here for updates.

http://www.mlive.com/news/kalamazoo/index.ssf/2012/04/former_congressman_patrick_ken_1.html

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Join us in the fight to end these discriminatory practices and let us know common consumer concerns. 

Complete our Parity Consumer Survey.

We will continue to assist with and file individual consumer and provider complaints, but once the data is collected and analyzed, we would like to also target complaints in a more strategic way, focusing on those that are affecting multiple providers and consumers. You may complete the survey anonymously or if you are interested in us following up with you regarding your survey or any potential complaints, please provide your contact information at the end of the survey.

Ensuring that the federal parity law achieves its goals of equitable insurance practice with respect to behavioral health coverage, cost, reimbursement and access may well be the most important foundation for us as we look toward the prospect of a radically changed health care system in the coming years.

Please Contact Us if you are in need of any assistance in filing complaints or appeals and please consider donating to support the Maryland Parity Project if you are supportive of our efforts.

Mrs. Carter who was strong advocate for the law’s passage expressed her worry that the law is not being fully implemented. She also pointed out that the states’ flexibility in determining the essential health benefit plans may also undermine the full impact of the law.

We need to support such strong advocates as the Carters in their efforts to see the law fully implemented and meet Congressional intent. Please consider attending the DC Metro  Parity Field Hearing to be held in Friendship Heights on June 26th. Contact Us for more details or to sign up for alerts.

We have a long way to go to remove stigmas and enable people to fully access behavioral health treatment, but convincing employers and insurers that providing coverage for such necessary care is not only appropriate but also affordable is a small step down the right road.

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Please Contact Us if you have questions or need help with a potential parity complaint.

In an Op-ed in the April 12th edition of the Washington Post, entitled Waiting for Mental Health Parity the former senators point out some of the many gray areas still remaining that are delaying individuals’ ability to access necessary behavioral health care. They illustrate that without the final regulations, there can be no clarity in the requirements. This lack of clarity allows continued insurer discrimination for people with mental illness and perpetuates the stigma that we are working so hard to end.

To stay up to date on parity information in Maryland and around the U.S., Sign Up for Alerts.

Please Contact Us if you have any questions or need help with a potential parity complaint.

Some interesting findings in the 45 page report include:

• Special issues were identified for managed behavioral health organizations because of their unique situation of not having access to the NQTL criteria, processes and procedures for medical services.
• Industry reps gave examples of some uncovered services due to lack of medical necessity: ABA treatment for autism (educational not medical) and psychological testing (subject to abuse).
• Industry reps expressed concern that outpatient behavioral health treatment is not analogous to outpatient medical treatment because the potential for misuse is much higher.
• Members of the expert panel recognized that network panel adequacy is a non quantitative treatment limitation, therefore fees so low for behavioral health services that a lack of providers willing to accept them creates an inadequate panel could be a parity violation.
• In the scope of service analysis, RAND found that behavioral health treatment makes up only $12 of the $268 per member per month health care costs. Of that $12, more than 60% is spent on prescription drugs, and only 20% is spent on intermediate services for those plans that currently provide them.

It is likely that this study will impact the specificity of the not yet released, final regulations for the Mental Health Parity and Addiction Equity Act.  For more information on this report or to stay up to date on the regulatory process- Sign Up for Alerts

Michigan Legislators Try to Add Mental Health Parity to Autism Legislation

Bi-partisan legislation requiring insurers to cover autism treatment is headed to the Governor’s desk from the Michigan Legislature. During the debate some legislators tried to amend the bill to include mental health parity provisions, and while some of the sponsors were amenable to this addition, it became clear the legislation would not succeed with additional mandates.

Washington

Judge Rules Insurer Must Cover Autism Treatment or be in Violation of Washington State Parity Law

King County Superior Court judge ruled that the insurer’s exclusion for all developmental disabilities violates the Washington State Parity Law. This is a preliminary ruling as the lawyer in the case has asked that it be certified as a class-action lawsuit.