They’re here! The long anticipated regulations for the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) were released this morning. In the coming days we will be closely analyzing the interim rule and getting you more information on what we can expect for implementation of MHPAEA. In the meantime, I have attached a fact sheet released by the three Departments issuing the regulations and have highlighted a few further points of interest. I have also included a link to the regulations for your review.
Effective Dates: The Departments of Health and Human Services (HHS), Labor (DOL), and the Treasury released interim rules this morning, and they will be published to the Federal Register on Tuesday, February 2, 2010. The regulations become effective on April 5, 2010 and apply to plan years beginning on or after July 1, 2010. Since the law has been in effect since October 3, 2009, plans should currently be making best faith efforts to comply with the intent of the law.
Opportunity to Comment: The regulations released today are interim final rules, so there will be one more opportunity to comment on them before the final rule is released. (Note: Even if the final rule is not released by July 1, 2010, plans must comply with the interim final rule.) The attached fact sheet contains some of the areas on which the Departments especially want feedback. We will be preparing comments and will share them with the field. The comment period is open immediately and will close on May 3, 2010.
Six Classifications: The regulations clarify that the parity requirements will be applied against “substantially all” medical/surgical benefits in six classification areas. Those six classifications are inpatient/in-network, inpatient/out-of-network, outpatient/in-network, outpatient/out-of-network, emergency department, and prescription drugs. Plans offering mental health and substance use coverage must provide parity in all classification areas where medical/surgical benefits are offered.
Quantitative v. Non-quantitative Treatment Limitations: The regulations distinguish between quantitative and non-quantitative treatment limitations. Quantitative treatment limitations include frequency of treatment, number of visits, and days of coverage, and must be at parity with substantially all medical/surgical benefits. The Departments give separate guidance with examples of parity with medical/surgical benefits for non-quantitative treatment limitations like medical management and utilization management. We will be reviewing the non-quantitative treatment limitations guidance to ensure that the regulations cover all scenarios where treatment can be limited by these types of mechanisms.
Deductibles: Deductibles for mental health and substance use benefits cannot be separate from medical/surgical benefits. Mental health and substance use benefits and medical/surgical benefits must have combined deductibles for financial restrictions and quantitative treatment limitations.
Mental Health as a Non-specialty: Mental health and substance use benefits will not be treated as a specialty, but must be at parity with the predominant medical/surgical non-specialty benefits offered by an insurance plan.
Medicaid Managed Care Organizations (MCOs): While the MHPAEA applies to Medicaid managed care plans, the regulations released today do not. Separate rules for Medicaid MCOs will be released by CMS. We will monitor the release of those rules and update you when they are available.
Non-compliance and Complaints: The Departments are tracking non-compliance and complaints, as well as fielding questions about the regulations. We will send the information on how to determine compliance, file a complaint, and obtain further guidance from the Departments. MHA is also tracking non-compliance and benefit terminations, so please send examples of these to me at ssteverman@mentalhealthamerica.net.
Regulations Link: http://www.federalregister.gov/OFRUpload/OFRData/2010-02167_PI.pdf.
We will have more information and analysis for you in the next several days and weeks. We will also continue to update you on our public education and advocacy campaigns around the implementation of MHPAEA, and look forward to working closely with our affiliates on these initiatives.
Friday, January 29, 2010
Monday, January 25, 2010
Letter from Rusty Selix: OPPOSE Governor’s Proposal to Divert Proposition 63 Funds
January 22, 2010
TO: All Members of the Senate Budget and Fiscal Review Committee
RE: Committee Budget Oversight Hearing on Tuesday, January 26, 2010
OPPOSE Governor’s Proposal to Divert Proposition 63 Funds
TAKING PROPOSITION 63 FUNDS MAKES NO SENSE
Just as he did a year ago, the Governor has proposed diverting voter approved Proposition 63 community mental health funds to balance the State Budget.
This makes no sense, not only because the voters overwhelmingly rejected this last year, but also because the Legislative Analyst and Department of Finance acknowledged to the voters when Proposition 63 was passed that:
“The expansion of county mental health services would probably result in savings on state prison and county jail operations, medical care, homeless shelters, and social services programs (that)…could amount to as much as hundreds of millions of dollars annually.”
So, not only is this a proposal that flies in the face of the voters’ expressions, both in passing the measure in 2004 and rejecting similar cuts in 2009, but it also won’t save money. It would wind up costing the State more in health, social services, and prison costs, and makes future Budget problems even worse.
Sincerely,
Rusty Selix
Co-Author with President pro Tempore Darrell Steinberg of Proposition 63 &
Executive Director
TO: All Members of the Senate Budget and Fiscal Review Committee
RE: Committee Budget Oversight Hearing on Tuesday, January 26, 2010
OPPOSE Governor’s Proposal to Divert Proposition 63 Funds
TAKING PROPOSITION 63 FUNDS MAKES NO SENSE
Just as he did a year ago, the Governor has proposed diverting voter approved Proposition 63 community mental health funds to balance the State Budget.
This makes no sense, not only because the voters overwhelmingly rejected this last year, but also because the Legislative Analyst and Department of Finance acknowledged to the voters when Proposition 63 was passed that:
“The expansion of county mental health services would probably result in savings on state prison and county jail operations, medical care, homeless shelters, and social services programs (that)…could amount to as much as hundreds of millions of dollars annually.”
So, not only is this a proposal that flies in the face of the voters’ expressions, both in passing the measure in 2004 and rejecting similar cuts in 2009, but it also won’t save money. It would wind up costing the State more in health, social services, and prison costs, and makes future Budget problems even worse.
Sincerely,
Rusty Selix
Co-Author with President pro Tempore Darrell Steinberg of Proposition 63 &
Executive Director
Tuesday, January 19, 2010
More than the Winter Blues: Seasonal Affective Disorder
Just as it seems to do each year, fall has rushed past and winter is at our doors. For some this is an exciting time, involving holidays spent with loved ones, warm nights snuggled by the fire and cool, sunny afternoons at the beach. However, for up to eight million Americans who suffer with seasonal affective disorder, this time of year can be very difficult.
SAD is a mood disorder associated with depression and related to seasonal variations of light. Brought on by the shorter days and longer nights, symptoms disappear completely in the spring. They include:
• Sleep Problems – Desire to oversleep, disturbed sleep or difficulty staying awake
• Lethargy – A feeling of fatigue and inability to carry out normal routines
• Overeating – Craving sugary or starchy foods
• Social Problems – Irritability and desire to avoid social situations
• Anxiety – Tension and inability to tolerate stress
• Loss of Libido – Decreased interest in sex or physical contact
• Mood Changes – Extremes in mood and/or short periods of hypomania
These symptoms can significantly disrupt one’s life. Yet those who experience SAD do not have to suffer through the winter. There are many options to help them feel better.
Phototherapy, or bright light therapy, has shown to suppress the brain’s production of melatonin, a chemical linked to SAD. The device most commonly used is called a “light box.” There are also a variety of light bulbs available that offer the same benefit, though their effects are milder and not scientifically proven. Typically, people need to use bright light therapy for about 30 minutes each day throughout the fall and winter.
Increasing exposure to natural light also helps. In fact, a half-hour walk outside equates to two and a half hours of bright light therapy. Opening blinds and curtains to allow more light into your office and home is another way to increase natural light.
If light therapies do not work, people can work with their health care provider to identify other alternatives, such as antidepressant medications and therapy. However, these options can take over a month to show benefits and may come with unwanted side effects.
Regardless of which treatment a person determines to work best, relief is possible. People living with SAD do not need to remain in the dark. SAD is a real and common disorder, though it is one that can be effectively treated.
For more information or to find help, visit www.mhasd.org or call Mental Health America of San Diego County at 619-543-0412. The road to feeling better starts here.
SAD is a mood disorder associated with depression and related to seasonal variations of light. Brought on by the shorter days and longer nights, symptoms disappear completely in the spring. They include:
• Sleep Problems – Desire to oversleep, disturbed sleep or difficulty staying awake
• Lethargy – A feeling of fatigue and inability to carry out normal routines
• Overeating – Craving sugary or starchy foods
• Social Problems – Irritability and desire to avoid social situations
• Anxiety – Tension and inability to tolerate stress
• Loss of Libido – Decreased interest in sex or physical contact
• Mood Changes – Extremes in mood and/or short periods of hypomania
These symptoms can significantly disrupt one’s life. Yet those who experience SAD do not have to suffer through the winter. There are many options to help them feel better.
Phototherapy, or bright light therapy, has shown to suppress the brain’s production of melatonin, a chemical linked to SAD. The device most commonly used is called a “light box.” There are also a variety of light bulbs available that offer the same benefit, though their effects are milder and not scientifically proven. Typically, people need to use bright light therapy for about 30 minutes each day throughout the fall and winter.
Increasing exposure to natural light also helps. In fact, a half-hour walk outside equates to two and a half hours of bright light therapy. Opening blinds and curtains to allow more light into your office and home is another way to increase natural light.
If light therapies do not work, people can work with their health care provider to identify other alternatives, such as antidepressant medications and therapy. However, these options can take over a month to show benefits and may come with unwanted side effects.
Regardless of which treatment a person determines to work best, relief is possible. People living with SAD do not need to remain in the dark. SAD is a real and common disorder, though it is one that can be effectively treated.
For more information or to find help, visit www.mhasd.org or call Mental Health America of San Diego County at 619-543-0412. The road to feeling better starts here.
Monday, January 18, 2010
Mental Health America Calls On President To Reverse Policy Of Not Sending Condolence Letters To Families of Soldiers Who Complete Suicide
Mental Health America is calling on President Obama to reverse a long-standing, unwritten policy of not sending Presidential letters of condolence to the families of service members who have completed suicide.
A resolution adopted by Mental Health America’s Board of Directors states that a condolence letter can help eliminate the stigma and shame associated with suicide and provide emotional support to families.
“The lack of acknowledgment and condolence from the President can leave these families with an emotional vacuum and a feeling that somehow their sacrifices may not have been as great as others who died while in the military,” the resolution states.
Mental Health America is also circulating an online petition through its Facebook page (http://apps.facebook.com/causes/petitions/374) For those who aren’t on Facebook, go to http://www.change.org/actions/view/a_letter_for_every_life_lost).
“Our nation face a critical challenge as we welcome our troops back from war,” the petition state. “After bravely risking their lives for our country, these heroes and their families often return to strained relationships, depression and even Post-Traumatic Stress Disorder (PTSD). Our response as a grateful nation is critical, and there is a near epidemic of suicides among our Armed Forces.”
Last month, in an effort initiated by Reps. Dan Burton (R-Ind.) and Patrick Kennedy (D-R.I.), 46 House members sent a letter to the President asking him to reverse the policy.
“By overturning this policy on letters of condolence to the families of suicide victims, you can send a strong signal that you will not tolerate a culture in our armed forces that discriminates against those with a mental illness,” the lawmakers wrote.
Mental Health America and the House members also noted that current military funeral procedure treats both suicide and death in combat the same.
President Obama asked for a review of the policy several weeks ago. The White House said last month that is expects the review to be completed soon.
A resolution adopted by Mental Health America’s Board of Directors states that a condolence letter can help eliminate the stigma and shame associated with suicide and provide emotional support to families.
“The lack of acknowledgment and condolence from the President can leave these families with an emotional vacuum and a feeling that somehow their sacrifices may not have been as great as others who died while in the military,” the resolution states.
Mental Health America is also circulating an online petition through its Facebook page (http://apps.facebook.com/causes/petitions/374) For those who aren’t on Facebook, go to http://www.change.org/actions/view/a_letter_for_every_life_lost).
“Our nation face a critical challenge as we welcome our troops back from war,” the petition state. “After bravely risking their lives for our country, these heroes and their families often return to strained relationships, depression and even Post-Traumatic Stress Disorder (PTSD). Our response as a grateful nation is critical, and there is a near epidemic of suicides among our Armed Forces.”
Last month, in an effort initiated by Reps. Dan Burton (R-Ind.) and Patrick Kennedy (D-R.I.), 46 House members sent a letter to the President asking him to reverse the policy.
“By overturning this policy on letters of condolence to the families of suicide victims, you can send a strong signal that you will not tolerate a culture in our armed forces that discriminates against those with a mental illness,” the lawmakers wrote.
Mental Health America and the House members also noted that current military funeral procedure treats both suicide and death in combat the same.
President Obama asked for a review of the policy several weeks ago. The White House said last month that is expects the review to be completed soon.
Wednesday, January 13, 2010
Make a Mental Wellness New Year Resolution
As we enter the second decade of this century, Mental Health America offers these simple steps to make a mental wellness New Year Resolution.
• 1. Make a New Year's Resolution: Make it your New Year's Resolution to reduce stress and anxiety over the economy. Start by turning off the evening news and spending quality time with loved ones. Taking a step back will help you gain long-term perspective and focus on the people who matter most in your life.
• 2. Focus on Your Health: The relationship between physical health and mental health is important. Focus on finding the right balance in your diet, through exercise and getting a good night's sleep.
• 3. Don't Make Rash Decisions: Making any decision on the spur of the movement is never a good idea. Try not to react immediately to bad news.
• 4. Don't Stress Over the Things You Can't Control: Focus less on the things you can't control, like the stock market and the cost of living, and more on the things you can. Review your expenses and see where you can make cuts. Postpone that vacation or eat out a little less. Use the opportunity to find things to do with your loved ones that bring you closer and cost less, such as a family game night or handmade Christmas presents.
• 5. Don't be afraid to seek help: If the anxiety becomes too much, find someone you can talk to about what you're going through. Don't be afraid to ask for help from family members, friends, and a professional, if necessary. For a list of resources in your area, go to www.mentalhealthamerica.net.
According to Mental Health America, anxiety disorders are among the most common mental illnesses in America; more than 40 million are affected by these debilitating illnesses each year. One of the most common is Generalized Anxiety Disorder, also known as GAD, which is marked by chronic, exaggerated worry about everyday routine life events and activities. Symptoms lasting at least six months can include fatigue, trembling, muscle tension, headache, or nausea. For those experiencing GAD, help is available. For more information or referrals to local services, visit our online Frequently Asked Questions section at www.mentalhealthamerica.net/go/faqs, contact Mental Health America America of San Diego County at 619-543-0412.
• 1. Make a New Year's Resolution: Make it your New Year's Resolution to reduce stress and anxiety over the economy. Start by turning off the evening news and spending quality time with loved ones. Taking a step back will help you gain long-term perspective and focus on the people who matter most in your life.
• 2. Focus on Your Health: The relationship between physical health and mental health is important. Focus on finding the right balance in your diet, through exercise and getting a good night's sleep.
• 3. Don't Make Rash Decisions: Making any decision on the spur of the movement is never a good idea. Try not to react immediately to bad news.
• 4. Don't Stress Over the Things You Can't Control: Focus less on the things you can't control, like the stock market and the cost of living, and more on the things you can. Review your expenses and see where you can make cuts. Postpone that vacation or eat out a little less. Use the opportunity to find things to do with your loved ones that bring you closer and cost less, such as a family game night or handmade Christmas presents.
• 5. Don't be afraid to seek help: If the anxiety becomes too much, find someone you can talk to about what you're going through. Don't be afraid to ask for help from family members, friends, and a professional, if necessary. For a list of resources in your area, go to www.mentalhealthamerica.net.
According to Mental Health America, anxiety disorders are among the most common mental illnesses in America; more than 40 million are affected by these debilitating illnesses each year. One of the most common is Generalized Anxiety Disorder, also known as GAD, which is marked by chronic, exaggerated worry about everyday routine life events and activities. Symptoms lasting at least six months can include fatigue, trembling, muscle tension, headache, or nausea. For those experiencing GAD, help is available. For more information or referrals to local services, visit our online Frequently Asked Questions section at www.mentalhealthamerica.net/go/faqs, contact Mental Health America America of San Diego County at 619-543-0412.
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