More on Parity

One of our board members, Katherine Swain McClayton, Manager of Aftercare Planning at the Oliver-Pyatt Centers  has written an excellent blog on the Parity Rules.

Check out her blog here: http://oliverpyattcentersblog.com/parity-rules-determined-significant-on-many-levels/

Parity Final Rule and Eating Disorders

If you’ve read our previous blog, you know that the final rule for MHPAEA came out on Friday. EDC has taken a look at the regulation to determine how we anticipate it will affect eating disorders policy, and what we anticipate the implications to be.

As a reminder, MHPAEA applies only to health plans provided by employers with 50 workers or more, and individual plans purchased through the Exchange. These rules do not apply to people in government health insurance programs such as Medicaid or Medicare.

Overall, the EDC, like many mental health advocacy organizations, is very pleased with this final rule. This is a historic first step in ensuring that people with eating disorders are able to receive the treatment that they need to recover. The final rule does clarify that insurers must cover mental health disorders at parity with medical disorders. There are three primary issues in the regulation we want to highlight: residential treatment, plan standards and disclosure requirements. All three of these areas contain substantial victories for people trying to get coverage for eating disorders.

1. Residential Treatment

While the rule doesn't require that residential services be covered, it does say that if insurers offer "post-acute care services," then they must cover residential treatment and other intermediate services for mental health.

For example, if a plan classifies care in skilled nursing facilities or rehabilitation hospitals as inpatient benefits, then the plan must also treat any covered care in residential treatment facilities for mental health as an inpatient benefit.  This means that if your insurance plan covers, for example, residential rehabilitation after an accident, it must also cover comparable residential or inpatient treatment for eating disorders.

People with eating disorders have been consistently denied inpatient and residential care, while their insurance plans cover comparable medical services. The EDC has long argued this is in violation with MHPAEA, the regulations explicitly clarify this.

2. Medical Necessity Disclosure Requirements

The rule clarifies that people are entitled to information about the standards used by health plans to determine what kind of treatment they cover.

That is, the final regulations require plan administrators to make the plan’s medical necessity determination criteria available upon request to potential participants, beneficiaries, or contracting providers. This information is particularly valuable if people wish to file a complaint alleging that their eating disorder was not treated comparably to a medical one.

People receiving treatment for eating disorders have, unfortunately, experienced coverage denials (typically, inpatient or residential) because of medical necessity. For many consumers it has been nearly impossible to understand how the insurance company made their determination.  Insurers have refused to disclose how the determination of ‘medical necessity ’was made. In a tremendous victory, these regulations clarify that the rationale behind these decisions must be disclosed.

3. Plan Standards

Another regulation in the final rules we want to highlight is plan standards.  In setting up their provider network, if an insurer does not require a patient to go out of state to access post-acute care medical services, then it can not force patients with mental illnesses out of state to access behavioral health residential treatment services.

Additionally, an insurer may no longer exclude coverage for inpatient or residential, out-of-network treatment of mental health disorders when obtained outside of the state where the policy is written, when no similar exclusion  exists for medical benefits exists.

In fact, the final rule added two additional examples of non-quantitative treatment limits (NQTL) to the illustrative list: network tier design and restrictions based on geographic location, facility type, provider specialty and other criteria that limit the scope or duration of benefits for services provided under the plan or coverage. The new

examples clarify that plan or coverage restrictions based on geographic location, facility type, provider specialty, and other criteria that limit the scope or duration of benefits for services must comply with the NQTL parity standard.

EDC Succeeds in Parity Push!

The EDC has worked tirelessly, in the past two years to put pressure on the Administration to release the regulations for the Mental Health Parity Addiction Equity Act of 2008 and to clarify that eating disorders must be covered at parity (click here for more).

This morning the Department of Health and Human Services released their final regulations on the Mental Health Parity and Addiction Equity Act of 2008.  The EDC was part of a conversation this morning with HHS and the Substance Abuse Mental Health Services Administration where they outlined the final regulations. The EDC is excited about a number of the provisions.

While the final rule doesn’t require that residential services be covered, it does require that if a managed care organization (MCO) or health insurers offers “post-acute care services,” then they also must cover residential treatment and other intermediate services on the behavioral health side. Simply put, it means that if a health insurance plan covers chemotherapy [a post-acute oncology intervention after hospitalization], then it must cover residential treatment of substance use disorders or eating disorders. The rule ensures that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings.

Another, tremendous win for us, is that the final rule clarifies that parity applies to all plan standards, including geographic limits, family type limits, network adequacy.  As many of you have encountered, you’ve needed to travel out of state to treatment centers so this is tremendous.

The EDC is particularly encouraged by the network disclosure requirements, the final rule will require that MCO’s/Insurers disclose medical necessity definitions and the process used to construct NQTL.  This has long been a difficulty faced by people denied coverage for their eating disorders.

This is a tremendous victory for all of those who have struggled through getting insurance coverage at parity. Thank you to those who shared your stories with us, called your Members to advocate for parity, and of course, attended our lobby days. This is our victory together!

We are continuing to comb through the regulations, and will soon let you know what this all means for you. Stay tuned to our blog, or follow us on twitter, or like us on Facebook to get immediate updates.  

Help Support the EDC

One of our junior board members is supporting the EDC. Please consider supporting her, and supporting the EDC!

You can access her brochure here: https://drive.google.com/file/d/0B17m2UfA8Xu-TWJuUnFnQUF1czQ/edit?usp=sharing

Call to Action! EDC Opposes Michelle Obama's Appearance on Biggest Loser: Add Your Voice.

Weight stigma matters to the EDC. We are so concerned about the intersection of eating disorders and weight stigma that it was the focus of our congressional briefing last month. Viewing media that portrays negative stereotypes of overweight people, contributes to a variety of issues including: negative self-image, anorexia, bulimia, binge eating disorder, and more.  As Dr. Puhl underscored in her talk at the Congressional briefing, stigmatizing efforts to help those lose weight actually have a boomerang effect and create more health problems for overweight people. 

 

First Lady Michelle Obama is planning on appearing on NBC’s The Biggest Loser again. The Biggest Loser, unfortunately, is a show that exploits overweight people and reinforces negative stereotyping of overweight people. The show also encourages risky weight loss behaviors that are dangerous and cannot be maintained for an extended time.  Thus those who appear on the show typically gain the weight back, which poses both physical and mental health risks.  The Biggest Loser perpetuates weight stigma rather than promotes health. The EDC is working with BEDA, BingeBehavior.com and others to oppose her appearance on the show.

 

We support Michelle Obama’s nutrition work, but we’ve been concerned about her anti-obesity push for years. In fact the EDC has worked with Congress and other like-minded organizations to ask Michelle Obama to reframe her approach and focus on health not weight so that her efforts do not cause more harm.

 

We’d be happy to work with Michelle Obama’s office to come up with constructive ideas that promote nutrition and combat eating disorders. Unfortunately appearing on the Biggest Loser does neither of these things. We encourage you to sign the petition and call the First Lady’s office urging her to not appear on the Biggest Loser

 

How to do it:

1.  Sign this Petition

 

2.  Calling her office at 202-456-1414 and tell her to not appear on The Biggest Loser. Tell her why you care about this issue.  Encourage Michelle Obama to work with the EDC, BEDA and BingeBehavior.com  and other like-minded organizations to have a serious conversation about promoting healthy eating habits in way that also combats eating disorders.

A special thanks to BEDA and BingeBehavior for spearheading this effort!

Shutdowns, Obamacare and Parity: What Does it Mean?

If you’ve been following the news you know that the federal government is currently in partial shutdown mode. You likely also know, that the tension began when House conservatives attempted to pass a spending bill with a rider that would defund Obamacare. And compromises on spending have often included provisions that would delay the implementation of Healthcare Reform. So what does this mean for the EDC and for eating disorders?

The first very serious problem is that operating under a partial shutdown (or even a short-term continuing resolution, which is expected to be the solution reached through Congressional negotiations) is  the lack of sufficient funding for the Department of Health and Human Services. Currently there are not any robust eating disorders programs at HHS. The EDC has long advocated that HHS increase funding into eating disorders research and prevention programs. Operating at a minimal budget level makes it near impossible for HHS to increase its eating disorders programs.  Additionally sequestration (the across the board funding cuts) hurt the federal government's ability to focus on eating disorders policy. The current spending levels for eating disorders coverage are too little, and too little attention is currently given to eating disorders by the Department of Health and Human Services (HHS).  The EDC urges Congress to pass a robust appropriations bill funding HHS and and to direct HHS to increase research and prevention programs related to eating disorders.

The second issue to be aware is that the Exchanges opened for enrollment (see more here) on October 1.  Coverage purchased through the Exchanges will take effect on January 1. We are continuing to monitor the state plans, to work to ensure that they cover eating disorders at parity. It is imperative that the plans offered through the Exchanges cover eating disorders treatment. Most of the delays that are currently being discussed revolve around a device tax, that wouldn’t effect eating disorders coverage. Another compromise expected to be announced on Tuesday would involve Secretary Sebelius certifying that individuals receiving Obamacare subsidies meet the required income levels, again this would not have an impact on eating disorders coverage.

Another part of the operation of the Exchanges and additional insurance coverage, is the confusion over Mental Health Parity. We are continuing the work we’ve been doing on Mental Health Parity (see more here). The regulations still aren’t out, but we’ve heard from insiders on the Hill that the regulations are expected at the end of this year. Although, it remains unclear whether the timing will change given the recent shutdown. In addition to the two letters sent from Congress to Secretary Sebelius we also continue to put pressure on HHS to clarify that eating disorders covered at Parity

Another Successful Lobby Day!

Last Wednesday was our annual Fall Lobby Day. Once again it was a tremendous success!Thank you to all who came and spoke out on the need for Congress to address eating disorders through important policies!
 

EDC lobby day actually started Tuesday evening with our Awards reception. Dr. Rebecca Puhl was awarded the 2013 Excellence in Policy Research Award, Carmen Cool was awarded the 2013 Excellence in Advocacy Award, and Senator Tom Harkin (D-IA) received the EDC Lifetime Achievement in Policy Award. Senator Harkin has worked with the EDC as a powerful ally in the fight to end eating disorders for nearly a decade and we are grateful that he is such a champion for our cause. In addition to a moving speech, the Senator was able to meet many of our members that evening and hear their stories first hand.  

Wednesday started with message training, which prepared all of the teams for their meetings. Training was a wonderful opportunity to not only really hone our message and prepare for the day, but to share our stories and encourage each other. We left training for the Hill united with a strong and powerful voice.

 

At midday the EDC held a Congressional briefing “Fear of fat and weight stigma: The need to address eating disorders and obesity in tandem”. Representative Alcee Hastings of Florida, hosted the briefing and encouraged us to be persistent in our message. “Don’t write one letter” he said “write a thousand.” And so we will. We are so grateful for Representative Hastings he is a true champion for those with eating disorders. He was awarded with the EDC 2013 Excellence in Policy Award. A special thanks to all of our speakers: Johanna Kandel, Dr Rebecca Puhl, Dr Timothy Walsh, Chevese Turner, and April Winslow.

 

Then off we went to the halls of Congress armed with a powerful message, that the federal government has the power to dramatically reduce eating disorders, and to ensure that people with eating disorders receive the treatment they need. Our teams met with House and Senate offices throughout the day. Because of these meetings, we were able to educate offices on eating disorders, gain new sponsors for FREED, forge new partnerships, and build relationships with Congress.  

  

But the work doesn’t end with lobby day; it is just a beginning. In fact, we are working even harder on the Hill to capitalize on the important work done last week.  EDC continues to advocate and educate on the Hill, we are following up with offices and building on this strong foundation to advance our policy goals.

 

EDC lobby days are not only about making Members of Congress pay attention and pass legislation – they are also about empowering those who have suffered as a result of an eating disorder.  We stand together and break the silence.  As one advocate said at the end of the day describing her lobbying experience “It is humbling, gratifying, and utterly life changing.”

 

If you weren’t able to join us on the Hill, there is still time to be a virtual lobbyist to help our efforts. See the details here.

 

To see more pictures of Lobby day, check out our facebook page https://www.facebook.com/EatingDisordersCoalition