Public Policy Update: October 21, 2010
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October 21, 2010
The Medicare Open Enrollment Period for Prescription Drug Plans and Medicare Advantage plans will begin on November 15, 2010. This is the one time of the year in which all current beneficiaries can change their prescription drug plan (PDP) and individuals who wish to join a PDP may enroll. Clients who have Medicare Part D coverage may want to carefully evaluate their plan options for the upcoming year and choose a plan that best fits their needs. Beneficiaries will receive an “Annual Notice of Change” letter from their current plan. Many plans change from year to year, and beneficiaries should examine whether their current costs and covered prescriptions will change in 2011.
The Centers for Medicare and Medicaid Services (CMS) has made available on its website several resources to help beneficiaries understand their options and select the right plan for them:
- State-specific fact sheets providing ‘fast facts’ about each state's PDP enrollment and key dates
- FAQs and other information about the Low-Income Subsidy program to assist with outreach
- Medicare Prescription Drug Coverage Personal Information Worksheet, Things to Think about when You Compare Plans, and more resources to help beneficiaries select the right option
Additional resources about this year’s open enrollment period that may be helpful for providers and their clients include:
- Recording of an open enrollment training webinar with top officials at the Department of Health and Human Services
- Medicare Access for Patients Rx website (with a 2011 open enrollment guide coming soon)
With major Medicaid expansions set to begin in 2014, more patients than ever before will need access to services from community behavioral health providers — yet the behavioral health workforce is underpaid, and in many cases it is impossible for agencies to offer salaries that attract needed skills. Behavioral health agencies are relying upon a shrinking talent pool willing to make do with far less than they deserve. The National Council is committed to righting this wrong — to assertive advocacy for reimbursement rates that support adequate pay for all staff. But we need data from you to inform our advocacy and present a convincing case to policymakers.
If you have not already done so, please have your Human Resources take just 30 minutes to complete the Behavioral Health Salary Survey. The deadline has been extended to Nov 1, 2010 so that every organization has the opportunity to participate. The larger the sample size, the more effective our advocacy. Please email Kara Sweeney, Director of Membership, or call 202.684.3723 for more information or with questions.
On October 20, the state of Georgia and the U.S. Department of Justice reached an agreement in a lawsuit to move people with disabilities out of state-run institutions and into community-based care settings. The agreement, which is pending approval by a federal court, would slowly transition these individuals out of institutional care and into the community. About 9,000 Georgians with serious mental illness are expected to be affected. The settlement requires Georgia to provide a broad range of community-based services to the affected individuals, including mental health crisis response teams, transition teams to help individuals transition into the community, a toll-free number to provide resources on dealing with a psychiatric emergency, peer-support services and 24-hour crisis service centers.
In addition, Georgia will end admissions of individuals with developmental disabilities to state hospitals by July 1, 2011. These individuals will instead be cared for under home- and community-based services waivers and will receive support coordination to assist them in gaining access to medical, social, education, transportation, housing, nutritional, and other needed services. A full list of the terms of the settlement is available online.
The Social Security Administration has announced that effective Nov. 12, 2010, the process for determining disability eligibility will be expedited for persons with the most severe disabilities, reducing the wait time for individuals who have applied for disability benefits. New regulations published in the Federal Register allow disability examiners to make favorable determinations for adult cases under the agency’s Quick Disability Determination and Compassionate Allowance processes without medical or psychological consultant approval. The changes will help expedite the process for many individuals, while freeing medical and psychological consultants to work on the most complex cases. The full regulations are available online.
How are other states preparing for healthcare reform?
What lessons can you learn from successful programs in other communities?
What decisions and actions is your state responsible for under healthcare reform, and how can you work to make sure behavioral health agencies are included in the process?
Find the answers to these and other questions on MentalHealthcareReform.org in our brand new State Resources section. Here, you’ll find information and links to resources on a wide range of topics, from the financial impact reform will have on your state to the specific steps states have already taken to begin implementing reform. We’ll also be inviting guest bloggers from selected states to take questions on our blog and share helpful suggestions from their states. Stay tuned to MentalHealthcareReform.org to learn about upcoming guest bloggers and to view new state resources as they are posted.
If you or your clients’ insurance plan has denied coverage for certain behavioral health treatments, you’re not alone. In fact, insurance denials for behavioral health services are most common for:
- Residential care;
- Partial hospitalization and intensive outpatient care for addiction;
- Any care that exceeds the period necessary for, among other things, “short term evaluation, diagnosis or crisis stabilization;”
- Care that exceeds 20 visits to an office based clinician;
- Tests, services or drugs that are not deemed “medically necessary;” or
- Failure to secure preauthorization as required for every visit by a patient’s psychiatrist, psychologist or social worker.
If your clients have encountered any of these denials, you may have grounds to appeal the insurance decision. Under the 2008 Wellstone-Domenici Mental Health Parity and Addictions Equity Act, insurance companies may no longer be more restrictive in their coverage of behavioral health services than they are for medical/surgical services. To help providers and consumers understand the new law’s requirements and file successful appeals for behavioral health coverage, the Parity Implementation Coalition, of which the National Council is a member, has released the Parity Toolkit for Addiction & Mental Health Consumers, Providers, and Advocates. The toolkit includes a managed care appeals checklist, advice on how to get answers to your insurance-related questions, an overview of the appeals process, and critical information for filing an appeal. Click here to view the toolkit, or visit the Parity page of the National Council’s website for more information.
