The National Council today released a fact sheet detailing the major issues facing active-duty soldiers, veterans, and their families in seeking mental health and addictions services. As of December 2009, over 2,000,000 U.S. troops have been deployed to Iraq or Afghanistan since September 11, 2001.   Among the U.S. troops returning from Iraq and Afghanistan, nearly 40 percent of soldiers, a third of Marines, and half of the National Guard members report symptoms of psychological problems. Thirty-one percent of all Army soldiers and other military personnel who have experienced heavy combat in Iraq and Afghanistan also have at least one mental or psychosocial disorder. Problems facing returning soldiers include anxiety, depression, and PTSD in addition to substance abuse, TBI, family violence, and grief or bereavement.   

 

Our new fact sheet examines coverage options available to members of the armed forces and their families, along with the mental health/addictions benefits under each option. The fact sheet also supplies information on how to contract with the Veterans Administration or TriCare to provide services for members of the military. For additional resources on veterans and mental health, see the Veterans page of our website, and the Veterans issue of National Council Magazine.

 

 

 

The Department of Health and Human Services in July issued an interim final rule (IFR) providing for a streamlined process by which individuals can appeal insurance company decisions about their coverage, including both an internal claims and appeals and an external review process. While most states and insurance plans already have such processes in place, there is great variation in these plans. These regulations attempt to establish a baseline of consumer protections for healthcare beneficiaries in the private sector.

 

Under the new rules, new health plans beginning on or after September 23, 2010 must have an internal appeals process that allows consumers to appeal when a health plan denies a claim for a covered service or rescinds coverage. Plans must clearly explain to consumers the grounds for any denial, including the medical necessity criteria used. The rules also call for states to adopt specified standards for external review processes. HHS has issued a fact sheet explaining the IFR in greater detail.

 

The National Council has drafted comments to HHS in response to the IFR. Our draft comments urge HHS to increase transparency, strengthen consumer protections, and provide assistance to providers, who are often the key intermediaries between patients and insurance plans. The National Council is seeking input from members on our comments before we submit them to HHS. If you have thoughts or suggestions for improving the draft comments, please contact Stacey Larson at staceyl@thenationalcouncil.org by 5:00pm on Sept. 16.

 

 

 

Under the Patient Protection and Affordable Care Act, annual limits on the value of insurance benefits will be prohibited beginning in 2014. The law calls for restrictions on annual limits beginning this month. Te Department of Health and Human Services (HHS) has released guidance on these restrictions, including a process by which insurance plans may receive a 1-year waiver from compliance with the requirements.

 

In July, HHS published an interim final rule outlining the allowable annual limits on the dollar value of health benefits. These limits cannot be lower than: $750,000 for plan years beginning Sept. 23, 2010 to Sept. 22, 2011; $1.25 million for plan years beginning Sept. 23, 2011 to Sept. 22, 2012; $2 million for plan years beginning Sept. 23, 2012 to Dec. 31, 2013; and are prohibited thereafter. In a recent informational bulletin, HHS detailed the process by which plans may gain a 1-year exemption from these requirements. The guidance states that plans must prove that compliance “would result in a significant decrease in access to benefits or a significant increase in premiums.” The waiver option is available for only one year, and plans would have to reapply annually in accordance with future guidance from HHS.

 

 

 

Check out the National Council’s healthcare reform blog for the latest news about reform implementation, along with resources to help you learn about the law and take advantage of its many provisions. New this week on MentalHealthcareReform.org: