Parity Implementation Coalition Issues Revised Fact Sheet on Compliance with Parity Law 

 

 

 

 

 

 

 

The National Council is pleased to announce that since Hill Day 2010, 27 new cosponsors have signed on to H.R. 5040, the Health IT Extension for Behavioral Health Services Act. The total number of cosponsors on the bill is now 62, up from 35 on the morning before Hill Day. 

 

National Council advocates have almost met the challenge put forth by Vice President for Public Policy Chuck Ingoglia to enlist 30 new cosponsors for the bill, but we can’t stop yet! Was your Representative supportive of H.R. 5040 when you met with him or her on Hill Day? If so, we encourage you to follow up with their offices to remind them of the importance of this legislation and urge them to sign on! Click here to find your legislators’ contact information if you don’t have it already.

 

The current list of the 62 cosponsors for H.R. 5040 can be viewed online – just click “View Co-Sponsors” under the name of the original author of the bill, Rep. Patrick Kennedy. For more information about the bill, see the National Council’s fact sheet and FAQ document.

 

 

 

The Parity Implementation Coalition, of which the National Council is a member, has revised its fact sheet with answers to frequently asked questions about compliance with the Wellstone-Domenici Mental Health Parity and Addictions Equity Act. The FAQ is based on real examples of non-compliant policies, claims data and input from Parity Implementation Coalition members around country in 2010. For plan years beginning on or after July 1, 2010, covered plans that fail to comply with the law are subject to a $100 per member per violation fine.  For each of the non-compliance issues, this FAQ document provides a brief description of individual and provider rights under the law.  The FAQ is designed to be a tool in helping consumers and providers file requests for coverage and appeals of adverse benefit determinations. For more information, visit the Parity page of our website. 

 

 

 

The Department of Health and Human Services (HHS) last week issued interim final rules for insurance plans on required preventive coverage under the Patient Protection and Affordable Care Act. The new law mandated that insurers cover certain preventive services at no cost to beneficiaries but did not provide a full list of such services. The recently issued regulations specify that beginning on or after Sept. 23, 2010, new plans must cover preventive services with a grade of A or B from the U.S. Preventive Services Task Force, including the following behavioral health services:

A full list of the covered preventive services is available online. These regulations do not apply to existing plans, which are exempt from the requirement under a grandfather clause in the health reform law. However, other recently issued regulations place limitations on how much a plan can change and still be exempt from the requirements of the law. HHS estimates that the changes will affect coverage for 41 million individuals next year and 88 million individuals by 2013. 

 

 

 

The Centers for Medicare and Medicaid Services has issued a State Medicaid Director Letter providing guidance on how healthcare reform impacts home- and community-based services (HCBS) and the Money Follows the Person (MFP) Rebalancing Demonstration Program. The MFP program is designed to help states shift funding for long term care away from institutional services and into HCBS. Participating states receive enhanced federal funding for qualified services, technical assistance from long-term care experts, and reimbursement for supplemental services that are part of the MFP program but are not typically covered by Medicaid.

 

The healthcare reform law extends the MFP program by five years, to 2016, and appropriates an additional $2.25 billion for the program. The law also expands the definition of who is eligible to participate in MFP, reducing by half the number of days an individual must have been in an institution in order to qualify for the program. Additionally, the law makes MFP funds available to new states that are not currently participating in the demonstration project. In late July, CMS will issue a grant solicitation to give new states an opportunity to take advantage of the MFP funding. States will have 120 days from the date of the announcement to apply. Stay tuned to the Public Policy Update and the Technical Assistance Update to learn when the grant solicitation is released.

 

 

 

This week, the House Appropriations Committee and the Senate Appropriations Subcommittee for Transportation, Housing, and Urban Development (T-HUD) approved changes to the Fiscal Year 2011 T-HUD budget bill. Funding levels agreed upon in the two bills include:

The House Appropriations Committee and the Senate T-HUD Subcommittee approved differing amounts for the McKinney-Vento Homeless Assistance Grants, a program to support the prevention of and rapid resolution to homelessness:

In the House, the T-HUD bill must now go to the full chamber for approval; in the Senate, the next step for T-HUD is the full Appropriations Committee. For the latest information on the progress of the budget bills through Congress, stay tuned to the Public Policy Update and the Federal Budget page of our website.

 

 

 

The Patient Protection and Affordable Care Act included a provision to close the Medicare Part D coverage gap, or “donut hole.” Currently, Medicare beneficiaries who exhaust their initial level of drug coverage are responsible for 100% of their costs until they reach the out-of-pocket threshold where catastrophic coverage becomes available. In 2010, enrollees reaching the bottom threshold of the gap have to pay $3,610 plus premiums before they reach the top threshold and coverage resumes. Under healthcare reform, the donut hole will be eliminated by 2020 through a gradual process of issuing rebates, providing for discounts on drugs in the donut hole, and decreasing beneficiaries’ level of cost-sharing for drugs in the donut hole. The National Council has issued a fact sheet on Medicare Part D and healthcare reform which explains in detail the process for closing the donut hole and links to additional resources for more information.

 

Please visit the National Council’s healthcare reform blog to download other resources about the Patient Protection & Affordable Care Act and its impact on mental health and addiction services.