LEGISLATIVE UPDATE
WASHINGTON, D.C., April 27, 2010
Harkin, Klobuchar,
Franken Introduce
First Senate Bill to
Confront Eating
Disorders in the U.S.
WASHINGTON, D.C. – Senators Tom Harkin (D-IA), Amy Klobuchar (D-MN) and Al Franken (D-MN) introduced legislation today aimed at fighting and preventing eating disorders in the United States. The Federal Response to Eliminate Eating Disorders (FREED) Act is the first comprehensive legislative effort introduced in the Senate to confront the seriousness of these diseases and to jump start research as well as improve the prevention, screening, diagnosis and treatment of eating disorders. It expands federal research, improves tracking and recording of the actual numbers of people suffering and dying from these diseases, provides training for a wide array of health professionals and educators to better identify and screen for eating disorders, creates a new patient advocacy program to help patients get proper care, authorizes grants for eating disorder prevention programs and builds on the mental health parity and health care reform bills to improve access to treatment, particularly for teens covered by Medicaid.
Click here for the full press release
WASHINGTON, D.C., November 4, 2009
CMS Releases State Health Official Letter Regarding Mental Health
and Substance Use Disorder Parity in CHIP and Medicaid
Today, the Centers for Medicare & Medicaid Services (CMS) released a State Health Official (SHO) letter to provide general guidance to States on the implementation of mental health and substance use disorder parity requirements for Children's Health Insurance Program (CHIP) State plans, as required by section 502 of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Public Law 111-3. This letter also provides preliminary guidance to the extent that mental health and substance use disorder parity requirements apply to State Medicaid programs.
Effective April 1, 2009, a CHIP State plan must comply with the requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), Public Law 110-343, which extended mental health parity requirements to substance use disorder benefits, and required parity with regard to financial requirements (e.g., co-payments) and treatment limitations. A CHIP State plan is deemed to satisfy the mental health and substance use disorder parity requirements if it provides coverage of Early and Periodic, Screening, Diagnostic and Treatment (EPSDT) benefits. In addition, a State that contracts with one or more managed care organizations (MCOs) or Prepaid Inpatient Health Plans (PIHPs) to provide Medicaid medical/surgical benefits as well as mental health or substance use disorder benefits must meet the parity requirements of MHPAEA for contract years beginning after October 3, 2009.
Until the MHPAEA regulations are issued or other guidance is provided, States will not have detailed information regarding how specific provisions in MHPAEA will be interpreted. However, CHIPRA provides that Federal financial participation in both CHIP and Medicaid shall not be denied if States make a good faith effort to comply with the requirements prior to the issuance of any regulations or guidance implementing the provisions in question.
Click here to read the full SHO letter
WASHINGTON, D.C., February 25, 2009
PRESS CONFERENCE INTRODUCING
THE FREED ACT!
The EDC stood by Congressman Patrick Kennedy as he introduced the landmark Federal Response to Eliminate Eating Disorders Act, or the FREED Act (H.R. 1193), on February, 25 2009 at a press conference on Capitol Hill. Speakers at the event included the Congressman, Mindy Richert, EDC board member Gail Schoenbach, and EDC Policy Director Jeanine Cogan. "This is a historic day for us, a historic day for Congress as we celebrate the introduction of the first ever comprehensive eating disorders bill since Congress was founded. While it took more than 200 years for this bill to be introduced we are confident the FREED Act will pass quickly!" Cogan said.
The FREED Act will offer federal action for research, treatment, and prevention efforts. It will provide support for the kind of focused and coordinated research efforts on eating disorders that have previously been underfunded compared to every other psychiatric illness. By funding Centers of Excellence we will benefit from a nationwide research infrastructure to collect data on prevalence, incidence, death rates, treatment program efficacy, and strategies for prevention.
The bill also strives to ensure access to care, which every American with an eating disorder deserves. It requires any insurer providing health coverage for physical illness to also provide coverage for eating disorders in accordance with national standards of care.
Lastly, the bill focuses on prevention by educating the public on advancements in scientific research in the field. It will also offer a grant program to universities to train health professionals in how to identify, prevent, and treat eating disorders.
In describing the bill, Kitty Westin, EDC’s President, said, “This bill is the solution to the devastation that is caused by eating disorders. It offers answers, brings hope and will save lives. I applaud Congressman Kennedy for his leadership on this issue.”
WASHINGTON, D.C., October 3, 2008
VICTORY IN PASSING MENTAL
HEALTH PARITY!
The EDC applauds Congress for their commitment to eliminating discrimination in health care coverage against people suffering from mental disorders. After tireless negotiations between differing House and Senate versions, both chambers came together to pass mental health parity this year. This bill requires group health plans that currently offer coverage for mental health and substance-use disorders to provide those benefits in the same manner as benefits provided to all other medical and surgical procedures covered under the plan. It also prohibits group health plans from imposing discriminatory annual/lifetime dollar limits, copays and deductibles, or day and visit limits unless similar limitations or requirements are imposed for other medical and surgical benefits.
“Everyday we get calls from parents whose kids are on the verge of death due to an eating disorder yet they cannot get their health insurance companies to pay for this life saving treatment. This law will change that.” says Jeanine Cogan, EDC Policy Director. The EDC was part of a broad based coalition of organizations actively advocating for the strongest mental health parity bill that could pass Congress this year. EDC President Kitty Westin was invited to testify before Congress to help make the case for a strong mental health parity bill and she spent many days in Washington DC lobbying with fellow advocates including David Wellstone, son of the late Senator Paul Wellstone, who first introduced parity legislation in 1996. Kitty stated, “I am thrilled that we finally have a mental health parity bill that will close some of the loopholes in the earlier version. It was a long hard battle and we are proud that we played a key role in passing a bill that will help millions of people each year.”
There were two notable victories from this advocacy. First, the parity bill extends coverage to out-of-network providers if that same coverage is available for physical illnesses. Therefore, if out-of-network benefits are extended to medical and surgical benefits under the plan, out-of-network benefits are extended to mental health and addictive disorders in a manner that is no more restrictive than the application of the terms and conditions with respect to the medical or surgical benefits as well.
Second, it ensures that stronger state parity laws already existing will remain intact. Whereas this parity law is similar to the one passed in 1996 in terms of the definition of mental illnesses, the EDC hoped to strengthen that definition by explicitly requiring all mental illnesses in the DSM to be covered. This was one of the provisions which did not survive negotiations. As a next step, the EDC will continue to advocate for provisions that require coverage for eating disorders treatment. As a compromise for conceding on the DSM, this bill directs the Government Accountability Office (GAO) to provide a report to Congress within three years of enactment of the bill on: Specific coverage rates for all mental health and substance use disorder conditions; Which diagnoses are most commonly covered or excluded; Whether implementation of the Act has affected trends in coverage or exclusion of mentalhealth and substance use disorder conditions; And the impact of covering or excluding specific diagnoses on participants’ and enrollees’ health, health care coverage and the cost of delivering care.
While plans will retain the right to manage the benefit as they see fit and determine the scope of coverage, plans will have to provide to plan participants and employers the terms and conditions of the medical necessity criteria used by the plan upon request.