Action Alert! Send your comments by midnight (EST) on January 31, 2012
The Eating Disorders Coalition for Research, Policy & Action asks you to respond to a Bulletin by Heath and Human Services (HHS) that outlined their strategy for implementing the essential health benefits (EHB) of the Patient Protection and Affordable Care Act (ACA).The EDC was optimistic that with the passage of ACA and the inclusion of mental health as an essential health benefit, the continued and widespread insurance discrimination experienced by people with eating disorders would come to an end.
Join us in asking HHS to capitalize on this moment in history and incorporate the following 3 recommendations so that people with eating disorders will finally have access to the life saving treatment they are often denied.
Please send comments to EssentialHealthBenefits@cms.
Urge the Secretary of HHS to:
1. Replace the sizeable flexibility given to the states with national uniform standards for the EHB categories.
When Congress passed the ACA and created the EHB they intended to create a uniform minimum benefit standard that would apply to all States in order to correct existing disparities. Providing national standards that include the treatment of eating disorders would guarantee uniformity across states.
Currently the options for eating disorders treatment are highly variable based on where a person lives. A state such as Rhode Island with a comprehensive state parity law requires insurance companies to provide eating disorder treatment so that individuals in that state have options for care. Contrast this with states like Wyoming and Arkansas that have no parity law and no eating disorder treatment available within the state, yet based on national prevalence data, these two states alone likely have over 75,000 individuals with eating disorders within their borders.
In the absence of a uniform standard, we believe there is a significant risk that eating disorders will continue to be inadequately covered in many States.
We urge HHS to provide concrete language defining the EHB for mental health, which requires the coverage of eating disorders.
2. Provide a federal definition of medical necessity that is broad and inclusive.
The degree to which Americans enjoy full access to covered services within the ten EHB categories will depend, to a large degree, on the medical necessity standards that plans use to determine whether a service within these categories is covered.
Few regulations address the definition of medical necessity: there is no federal definition, and only about one-third of states have any regulatory standards for medical necessity. Consequently, the definition of “medical necessity” is most commonly found in individual insurance contracts that are defined by the insurer. As a result, the standard of medical necessity is most often controlled by the insurer, not the treating professional.
This has dire consequences for people suffering from eating disorders who are continually discharged from treatment or denied treatment based on erroneous and shifting definitions of medical necessity, per insurers.
We urge HHS to offer a federal definition of medical necessity that 1) is broad enough to include all clinically necessary levels of care for eating disorders and 2) requires insurers to use well respected, clinically proven or evidence based criteria for the effective treatment of mental illness.
3. Eliminate eating disorders from exclusion lists.
Exclusion of eating disorders is all too common on the part of insurers seeking to limit interventions deemed non-essential. Despite being biologically based mental illnesses with severe physical health complications, including death, eating disorders are all too often found on lists of benefit exclusions.
We urge HHS to ensure that eating disorders treatment is no longer specifically excluded and end the discrimination against individuals with eating disorders.
Please send your comments outlining the need for these 3 recommendations and include examples from your personal and/or clinical experiences as relevant.
Send comments to EssentialHealthBenefits@cms.
**Please also send your comments to: firstname.lastname@example.org