Hi! Many of you know that I recently spoke in Washington, D.C. at a Congressional Briefing held by the Eating Disorders Coalition (EDC). For years, the EDC has worked hard in D.C. on behalf of eating disorders. I am thrilled to post this update from the Executive Director of the EDC, David Jaffe.
P.S. I am headed to Hershey, PA, and State College, PA, right now for several presentations. Please visit my website (http://www.lifewithouted.com/calendar.php) and see me if you can!
October 3, 2008
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 states, “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 of this advocacy. First the parity bill extends coverage to out-of-network providers if that same coverage is available for physical illnesses. Thus, 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 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 mental
health and substance use disorder conditions; and
The impact of covering or excluding specific diagnoses on participants’ and enrollees’ health,
their 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.
For More Information:
Eating Disorders Coalition for Research, Policy, and Action
David Jaffe, Executive Director