Legislation of interest to people with mental illness and their families follows.
Coalition for Healthy Communities Budget Platform
The coalition’s platform, “Treatment Works: Minding the Bottom Line for Good Mental Health and Addiction Recovery,” seeks to have Ohio’s workforce understand that good mental health and freedom from addictive behavior will increase their businesses bottom line. By funding essential mental health services, Ohioans with mental illness and addictions can contribute to their communities and Ohio’s economy.
Parity Bill Update
Dr. S.R. Thorward, Twin Valley Behavioral Healthcare, Governor Bob Taft, and MHAFC Executive Director Laura Moskow Sigal after the signing of Ohio's Mental Health Parity Bill, SB 116.
Ohio Mental Health Parity, SB 116 :
Governor Taft signed SB 116 into law on December 29, 2006. The law will take effect 9 months from the date of signature.
On Thursday, December 14th, the Ohio House passed the mental health parity bill, SB 116, with a vote of 69 to 24. An amendment sent it back to the Senate for concurrance, which passed with a 23 to 7 vote.
On Wednesday, December 13th, the House Health Committee passed S B116 with a vote of 15 to 6 sending the bill to the full house on December 14th.
On Tuesday, December 5th, the Ohio Senate passed SB116, the Mental Parity Bill, with a 26 to 5 vote. We would like to thank Senator Spada, who did an outstanding job testifying on the bill.
Background on Mental Health Parity
Current law mandates health insurance policies sold in the state provide specific levels of coverage for certain illnesses and procedures. The basic premise is that if you're going to sell insurance in the state of Ohio you have to treat mental illness with the same evel coverage as you treat other illnesses.
In answer to opponents' concern about driving up premium costs there is an opt-out provision in the event an increase exceeds one percent. There is an availability problem as well when trying to add the expanded mental health coverage for employees in a small business operation. It's not always available. If you're an Owens-Illinois and you've got 25,000 employees you can tailor your benefits. That flexibility doesn't exist for small plans. It's not just an issue of cost. It's an issue of access. Some proponents maintain there would be no increased costs through mental health parity, and that such a provision would save money because properly diagnosed and treated atients could return to work.
The Ohio State Medical Association, the Ohio Psychiatric Association, and the Coalition for Healthy Communities are among those who support the legislation.
Opposition comes from the Ohio Chamber of Commerce, the Ohio Manufacturers' Association, and the National Federation of Independent Business.
Failure to Enact: The Consequences.
Parity does not increase medical plan costs.
Parity Toolkit and Brochure.
Major Study of Parity Cost Proves Its Affordability
The time is right to push for parity in Medicare for mental health benefits, including substance abuse, according to APA President Steven Sharfstein, M.D.
A long-awaited report on the results of offering parity through the Federal Employees Health Benefits (FEHB) program provides powerful evidence that can be used to refute claims that parity is unaffordable. The release of "Evaluation of Parity in the Federal Employees Health Benefits (FEHB) Program: Final Report" came shortly before the introduction of the Medicare Copayment Equity Act by Sens. Olympia Snowe (R-Maine) and John Kerry (D-Mass.) in late May (Psychiatric News, July 1).
APA's Department of Government Relations led the effort to develop the legislation and mobilize support from the Mental Health Liaison Group, which in addition to APA represents more than 30 professional and advocacy organizations. The bill would end the 50 percent copayment required for outpatient psychiatric services funded through Medicare (Psychiatric News, July 1).
"We have yet another evaluation showing that parity does not break the bank," said Sharfstein. "This study is particularly impressive because it was national in scope and analyzed the effects of parity benefits in the largest employer-sponsored health insurance program in the country."
He added that President George W. Bush frequently has pointed to the FEHB program as a model insurance program. Health economist Thomas McGuire, Ph.D., offered another reason for the importance of the FEHB study.
"It was done by the `first string,'" he said. "These are the people and research organizations you would want to do the work."
The participating organizations included the Health Solutions division of Northrop Grumman Information Technology Inc., Department of Health Care Policy at Harvard Medical School, RAND Corporation, University of Maryland School of Medicine, and Westat.
The principal investigator was Howard Goldman, M.D., Ph.D., a professor of psychiatry at the University of Maryland and editor of Psychiatric Services. The study encompasses data from 1999 through 2002. The final report was submitted to the Department of Health and Human Services and the Office of Personnel Management at the end of 2004 and made public in May.
McGuire agreed with Sharfstein that the size and scope of the study give weight to the findings. "The FEHB [program] evaluation is the capstone of the line of research that has established the affordability of providing parity of benefits in health insurance," he said (see box on page 36 for key findings).
McGuire is a professor of health economics in the Department of Health Care Policy at Harvard Medical School and co-editor of the Journal of Health Economics.
The report is timely because the Mental Health Parity Act of 1996, which provides legislative authority for a limited federal parity mandate, will sunset at the end of the year unless it is reauthorized. The act has been reauthorized annually since 2002.
Study Examines Effects of Policy Shift
Services to be covered were identified as "clinically proven treatment for mental illness and substance abuse.. .conditions listed in the DSM, Fourth Edition." OPM encouraged plans to manage the costs of care by such methods as the establishment and use of network providers. OPM did not require plans to provide parity in benefits for plan members who chose to use out-of-network providers.
The parity policy represented a genuine change in MH/SA benefits for the approximately 8 million individuals covered through FEHB insurance plans. Before implementation of parity, 98 percent of the plans continuously participating in the program over the four-year study period contained at least one benefit feature that was more restrictive for MH/SA care. Some health plans, for example, limited annual outpatient mental health care to 28 visits.
In fall 2000, the U.S. Department of Health and Human Services issued a contract for a study to evaluate the implementation and impact of the new policy in terms of changes in access, utilization, cost, quality of care, and other issues. The research was also supported by six other federal agencies.
Researchers Used Multiple Approaches
But the list of questions also included items that required more sophisticated and innovative methods of arriving at answers. Researchers were asked to determine whether the quality of care was affected by the parity policy and how providers "experienced" the policy.
Researchers studied data for major depression and substance abuse disorders, two tracer conditions, to assess changes in quality of care for these conditions. They compared claims information about treatment to determine whether patterns of care were consistent with practice guidelines.
Focus groups of psychiatrists, psychologists, and other mental health personnel in different regions of the country helped determine how providers experienced the change in policy. None reported a clear understanding about how the parity benefit affected service provision, and some confused federal with state parity requirements.
The most important set of questions concerned the impact of parity on cost, access, and utilization of MH/SA services. It was important for researchers to be able to separate the impact of parity on changes in those areas from changes that would have occurred without implementation of parity.
To identify health plans that did not offer parity but did offer mental health and substance abuse benefits typical of those offered by large employers, Goldman and his colleagues turned to a database by Med-Stat, a company that collects data about health plans.
"For purposes of comparison," he said, "we matched those plans with a set of similar FEHB plans that did offer parity." The aim, he said, was to come as close as possible to designing an experiment that would determine whether changes in cost, access, and utilization were due to the implementation of parity or to other health care trends.
Both the FEHB and the MedStat plans showed similar increases in the items measured, suggesting that implementation of parity alone did not increase cost, access, and utilization.
An important difference, however, between plans offering parity benefits and those that did not was the cost to beneficiaries for MH/SA services.
When parity went into effect, all copays and limits were changed to comply with the new policy. The median copay dropped from $20 to $10 per visit for outpatient mental health services; for inpatient care, the respective figures were $40 and $0.
"Users of services in most but not all plans experienced a decrease in out-of-pocket spending, indicating that parity provided the intended additional financial protection for MH/SA expenditures for many enrollees," according to the report.
Use of Carveout Vendors Increased Slightly
Studies of the effects of implementation of parity at the state level found that costs typically increased "a few percent" and sometimes not at all and that implementation was accompanied by increased use of carveouts and other managed care measures intended to control costs (Psychiatric News, September 19, 2003; June 21, 2002; June 7, 2002).
FEHB plans were asked to report "whether the health plan contracts with a vendor—such as a managed behavioral health organization—for management of behavioral health benefits." Information was also elicited about whether carveouts were established post- or pre-parity and whether they were established in response to the parity policy.
Researchers separated the FEHB plans into two groups for administrative reasons. In the first group, 62 (26 percent) reported that they had carved out benefits either in anticipation of, or in response to, implementation of parity. Of the 156 plans in the second group, 103 (66 percent) reported having a contract with a carveout vendor to manage behavioral health care benefits. Eighty-one of the 103 plans, however, reported preexisting carveouts that were implemented for reasons other than FEHB parity.
Darrel Regier, M.D., M.P.H., director of the American Psychiatric Institute for Research and Education and APA's Division of Research, said, "The report provides an excellent foundation for our ongoing examination of how the implementation of parity affects psychiatrists and other providers of mental health services, in addition to valuable new information about cost and utilization."
He pointed out that important questions about the effects on the mental health workforce and on patient care remain unanswered. Among them: Did parity change the proportions of various kinds of mental health providers supported through the FEHB program? Did parity impact access for patients in terms of availability of specific kinds of providers?
With support from the American Psychiatric Foundation, Regier and his colleagues have been conducting a survey of Washington, D.C.–area psychiatrists to gain more information on the impact on psychiatrists and patients' access to care. Parallel surveys are being conducted by the American Psychological Association and the National Association of Social Workers.
"Although some questions remain about the impact of managed parity on clinical practitioners," Regier said, "the study provides convincing evidence that parity mental health benefits under the FEHB program reduced out-of-pocket costs for patients—particularly for those using inpatient services—and that ending discriminatory insurance coverage for patients with mental disorders is a completely affordable national health policy goal."
"Evaluation of Parity in the Federal Employees Health Benefits (FEHB) Program" is posted at <http://aspe.hhs.gov/daltcp/reports/parity.htm>.
GENERAL INFORMATION ON OHIO LEGISLATION :
If you have comments about Ohio legislation, please e-mail your legislator through this link: http://www.legislature.state.oh.us. Try to be succinct in your comments. Relay information about you or your family member's situation, and how the proposed legislation positively or negatively affects you.
The United Way of Central Ohio has a public policy site that is a source of legislative and policy information.
SENATE COMMITTEE PASSES FEDERAL MENTAL HEALTH PARITY BILL
MEDICARE PART D
The open enrollment period for the new part D program for all Medicare eligible persons will be Nov. 15, 2005 - May 15, 2006. Dual eligibles will be automatically enrolled in October. They will be able to change their plan through December 31, 2005. Medicare-only eligible persons will be able to change plans once a year during open enrollment. Those with Medicaid eligibility will be able to change anytime.
A new web service will help Medicare beneficiaries of limited income and resources gain access to extra help. This will also help beneficiaries take advantage of the low-income subsidy. This is the extra help that covers 95% of drug costs on average for Medicare-eligible people with limited income. NAMH has also prepared a workbook to assist Medicare recipients.
Substance Abuse and Mental Health Services Administration (SAMHSA) released "The Federal Action Agenda: First Steps" to follow-up on the Commission´s call for transforming America´s mental health system. The Campaign for Mental Health Reform views as a positive development SAMHSA´s coordination of multiple Federal agencies in developing an agenda to follow-up on the Commission and commends the leadership of Administrator Charles Curie and Director Kathryn Power. Click here to see the plan.
FEDERAL BUDGET UPDATE
Campaign for Mental Health Reform Statement on President Bush's Proposed FY2006 Budget
(For a budget update from the NMHA, click here)
WASHINGTON, DC-A national coalition of groups representing millions of people with mental or emotional disorders, their families, service providers, administrators and other concerned Americans today condemned President Bush's proposed FY2006 budget for undermining already overburdened services that are crucial to people with mental illnesses.
The following is a prepared statement by William Emmet, campaign coordinator for the Campaign for Mental Health Reform:
"The President's budget - and the disregard it shows for the urgent need to address unmet mental health needs in America - is incredibly disappointing.
In April 2002, President Bush announced the formation of his New Freedom Commission on Mental Health, remarking that 'our country must make a commitment to Americans with mental illnesses.' Unfortunately, the Administration has done little to honor its pledge.
Since the President's Commission on Mental Health released its final report in July 2003, more than 40 thousand adults and children with mental health disorders have died by suicide and the U.S. economy has lost more than $118.5 million in worker productivity due to mental illness. Yet, the Administration maintains only tepid support for concrete action to address this public health crisis.
At a time when the Administration should be offering bold proposals to address major problems in public mental health systems, it has instead proposed tens of billions of dollars in cuts to Medicaid - the largest public funder of mental health services - and slashed discretionary spending on mental health.
The rare bright spots in this bleak budget picture are
There are even darker clouds on the horizon. The
Additional details on the budget are available on the ampaign for Mental Health Reform's website at
Advocates Push for Passage of Keeping Families Together Act This Year
Mental health advocates are pushing for passage this year of the Keeping Families Together Act, critical legislation to improve access to children’s mental health services and reduce families’ need to relinquish custody of their child to obtain necessary services. Senator Susan Collins (R-ME) and other children’s advocates introduced the bill in the last ongress and plan to do so again this year. Passage of the bill gained new immediacy last week following separate reports in California and Ohio about the high incidence of children with mental health needs ending up in state child welfare and juvenile justice systems.
Send an e-mail to your Representative and Senators urging them to sign on as an original co-sponsor of the Keeping Families Together Act.
Mental Health Parity Rule Extended Through 2005
Parity Legislation Effectively Blocked by Lobbyists
The Senator Paul Wellstone Mental Health Equitable Treatment Act of 2003 (S. 486/H.R. 953), was not brought to a vote in either the House or the Senate, despite 69 sponsors in the Senate and 246 sponsors in the House, clear majorities in both chambers. Status: House Speaker Dennis Hastert has declined to schedule a House vote. In the Senate, Republicans blocked an attempt to win passage last fall, on the one-year anniversary of Wellstone's death in a plane crash.
Proponents of mental health parity nationwide seek an end to discriminatory policies that severely limit insurance benefits for people with mental disorders. The introduction in the Senate and House of mental health parity legislation named for the late Sen. Wellstone highlights the glaring discrimination in health insurance that still routinely confronts people in need of mental health care.
According to an NMHA survey, 83 percent of Americans believe it's unfair for health insurance companies to limit mental health benefits and require people to pay much more out-of-pocket for mental health care than for any other medical care. And an overwhelming majority of Americans (79 percent) support parity legislation even if it results in an increase in their health insurance premiums.
The MHAFC, NMHA, Bazelon Center for Mental Health Law and mental health advocates at 250 national organizations are appealing to consumers and their families to contact senators and representatives to urge them to continue to support passage of the parity bill.
General Information on Federal Legislation
For current information on Federal legislation related to mental health, please visit the National Mental Health Association website at
If you are interested in helping Mental Health America of Franklin County advocate for positions on mental health care, please complete the form below and email it to us.
You will receive emails directly from the MHAFC asking you to write letters, email letters, or make phone calls to appropriate officials expressing your particular view about an issue. We always need individuals willing to advocate for the rights of persons with mental illness. Feel free to email this to friends and colleagues if you think they would be interested in helping us as well. Please contact us at any time to discuss these issues. We appreciate your support and involvement.