The Eating Disorders Coalition for Research, Policy & Action (EDC) Applauds the Supreme Court's Ruling to Uphold the Affordable Care Act.

This is a huge victory for millions of Americans needing health care coverage for eating disorders. Unfortunately too many people seeking treatment for eating disorders today are denied life saving care due to stonewalling tactics and inappropriate denials by health insurance companies. With the passage of the ACA and a number of key provisions such as the law's guarantee of coverage for people with pre-existing conditions and the requirement to cover mental health as an essential health benefit, some of the widespread discriminatory practices by insurance companies against people with eating disorders may come to an end. The ACA is an important step in holding insurance companies accountable. The EDC will continue our aggressive efforts to influence the implementation of the ACA at the Federal level so that people with eating disorders receive the treatment they need and deserve.

What the EDC has done?
-Attended regional forums with the Department of Health and Human Services (HHS) with specific recommendations to ensure treatment for eating disorders is part of the ACA.

-Submitted comments to HHS during the open comment periods with specific recommendations to ensure treatment for eating disorders is part of the ACA.

-Met more than once with key officials at HHS with specific recommendations to ensure treatment for eating disorders is part of the ACA.


What can you do?
Contact your state legislators and/or ACA implementation committee to learn how you can be part of the discussions and influence the process. Be a voice for eating disorders treatment and make sure that gets included in each state's implementation.

EDC Attends Mental Health Parity Field Hearing in Maryland

EDC Attends Mental Health Parity Field Hearing in Maryland with former Congressmen Kennedy & Ramstad

The event was standing room only and attended by approximately 250 people.  The forum was chaired by Rep. Chris Van Hollen (D-MD) and attended by former Reps. Patrick Kennedy and Jim Ramstad and current Members Moran (D-VA) and Tonko (D-NY).

Three panels of witnesses made a strong case for the need for full and robust implementation and enforcement of MHPAEA.  Witnessed included:

PANEL ONE

• Dr. Paul Berger
• Ann Price
• Adrian & Diana Veseth-Nelson

PANEL TWO

• Dr. Josh Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene
• John O’Brien, Director of Health Care and Insurance, Office of Personnel Management
• Brenda Wilson, Associate Commissioner, Life and Health Section, Maryland Insurance Administration
• Dr. Raymond Crowel, Chief of Behavioral Health and Crisis Services, Montgomery Country Department of Health and Human Services

PANEL THREE

• Dr. Steve Daviss, Chair of Psychiatry, Baltimore Washington Medical Center
• Ellen Weber, Professor of Law, University of Maryland Francis King Carey School of Law Drug Policy Clinic

First Panel

During the first panel, Dr. Berger, a dentist in recovery from addiction, and Ann Price, a career flight attendant with PTSD and in long-term recovery from addiction, talked about their struggles trying to get their insurers to pay for their treatment.  

Adrian and Diana Veseth-Nelson represented the veteran and military family voice; Captain Veseth-Nelson was medically retired from the Army last year after being diagnosed with severe PTSD following his second tour in Iraq.  He and his wife Diana talked about the stigma associated with mental illness and the need for robust treatment for both veterans and their family members. 

Second Panel

The second panel included local, state and federal government witnesses. First, Dr. Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene, spoke about the importance of the Affordable Care Act and said Maryland is committed to its full implementation unless stopped by the Supreme Court or some other body. 

Following Dr. Sharfstein, John O’Brien with the Office of Personnel Management talked about parity in the Federal Employee Benefits Program (FEHBP).  As you all know, President Clinton signed an executive order requiring parity for FEHBP plans.  While FEHBP does not have to comply with MHPAEA, following the law’s enactment, FEHBP required its carriers to comply with the stronger protections (such as out-of-work parity) in MHAPAEA than in the existing FEHBP parity requirements.  During the question and answer period following the panel’s statements, Rep. Kennedy asked Mr. O’Brien about recourse FEHBP takes with plans who are denying large numbers of claims and he replied that during the contract renewal process, they had made it clear to certain plans they were unhappy. 

Brenda Wilson with the Maryland Insurance Administration talked about Maryland’s history with parity and the state’s efforts to comply with MHPAEA.  During the question and answer period, Rep. Kennedy asked her why there had only been 30 complaints filed with her office in 2011 related to mental health and addiction treatment.  She replied that they do everything they can go get the word out that patients have a right to appeal, but she suspected the nature of the illnesses make it very difficult for patients and family members to go through the arduous appeals process.

Dr. Raymond Crowel with the Montgomery Country Department of Health and Human Services spoke about how non-quantitative treatment limits in Medicaid often limit access to care and he emphasized the need for requiring outcomes reporting to ensure patients are getting the care they need. 

Third Panel

On the third panel, Dr. Daviss with Baltimore Washington Medical Center echoed Dr. Crowel’s comments that non-quantitative treatment limits (NQTLs) often limit access to care. He talked about how obtaining pre-authorization for patients he sees in the emergency department who need to be admitted for psychiatric treatment is significantly more difficult than for patients his colleagues admit for medical/surgical treatment.  He also spoke about lack of providers in networks, a phenomenon called “phantom networks” where plans lists providers in their networks who are not really available to treat patients. 

Ellen Weber with the University of Maryland spoke about the need for a final rule that addresses the important outstanding issues of scope of service, NQTLs and application of MHPAEA to Medicaid managed care plans. Professor Weber talked about how it is difficult for patients to appeal because MHPAEA’s rules are complex, the plans control the information and patients and providers have limited capacity to spend the significant time required to file an appeal.

I thanked both Kennedy and Ramstad for their continued passionate efforts to make sure people with eating disorders receive the life saving care they need.  Be sure to attend the hearings near you. For schedule and information: http://parityispersonal.org/Parity_Field_Hearings

EDC Wins Big for Eating Disorders Research

Last week, the Senate Appropriations Committee agreed to FY 2013 funding for federally financed health research.  Under the leadership of the Eating Disorders Coalition for Research, Policy and Action (EDC), the funding bill contains a congressional directive urging the National Institute of Health (NIH) to expand, intensify, and coordinate its research on eating disorders and to examine the possibility of creating collaborative consortia on eating disorders research. This initiative holds out the prospect of attaining two key EDC goals: the first is greater attention to and the coordination of eating disorders research across nine National Institutes of Health who possess active research portfolios in this area; the second is increased support for federal Centers of Excellence in eating disorders research at academic medical centers and universities in the United States.  The EDC drew inspiration for this breakthrough initiative from the research sections of the House and Senate Federal Response to Eliminate Eating Disorders Act (the FREED Act). 

In short, the EDC is committed to an aggressive strategy intended to achieve key policy goals in Washington, D.C. through available legislative and regulatory vehicles.  The EDC has excellent relationships with senior officials at NIMH who we anticipate will be key players in implementing this critical congressional initiative.

Thank you 1Mind4Research

 The EDC is glad to be connected with One Mind for Research. Here are some highlights from their 1st Annual Meeting of the One Mind for Research Campaign.

Today, One Mind for Research issued a release to announce the highlights from its 1st Annual Meeting of the One Mind for Research Campaign: Curing Brain Disease. The energy and emotion of the conference, which was focused on advancing brain research, anti-stigma advocacy and mental health policy are captured in video highlights. A complete collection of videos from the meeting will be available later this month.

 

 

 

1st Annual Meeting of the One Mind for Research Campaign: Curing Brain Disease

June 6, 2012, Rutherford, CA – One Mind for Research completed its 1st Annual Meeting of the One Mind for Research Campaign: Curing Brain Disease on May 23-25, 2012 at the University of California, Los Angeles, firmly establishing itself as a leader in brain research, anti-stigma advocacy and mental health policy.

The conference was welcomed by Los Angeles Mayor Antonio Villaraigosa and UCLA Chancellor Gene Block and featured over 350 of the world’s leading scientists and researchers in a discussion of how to accelerate the next generation of innovative neuroscience discoveries. A video recap of the conference is available online at www.1mind4research.org beginning today. Complete videos of all of the presentations during the three-day event will be available soon.

The 2nd Annual One Mind for Research meeting will take place at Johns Hopkins University in Baltimore, Maryland. Tentative dates are May 21 -23, 2013.

Highlights of the 2012 conference, among many, included FasterCures chairman Michael Milken’s presentation on the bioscience revolution, noting that the cost of sequencing a genome has been reduced from millions of dollars to $1000, advancing the opportunities for genetic therapies.

Robert Klein, president of Klein Financial Corporation and author of California Proposition 71, the California Stem Cell and Cures $3 billion ballot initiative, presented an inspirational outline on the opportunities for innovative global research funding.

Michael Thompson of PricewaterhouseCoopers presented initial estimates of a study funded by One Mind on the costs of brain disease in the United States. Preliminary studies find costs approaching $1 trillion in 2012 alone. The final report is expected within weeks.

Patrick Kennedy inspired the attendees with his call to action for the Healthcare Parity Campaign and Emmy, Golden Globe and Tony Award winning actress Glenn Close chaired a panel on the science of stigma.

Among the keynote moments of the 2012 meeting was the presentation of the One Mind for Research TBI/PTS Knowledge Integration Network by Dr. Geoff Manley, UCSF. The TBI/PTS KIN is a digital environment for multiple-source data sharing, with open analysis tools, and tracking systems for working with complex data for those involved in the areas of TBI and PTS. This system will foster an open science approach among academia, industry, non-profits and governments, to remove the barriers to effective scientific and clinical research that will increase collaboration, and speed diagnosis and treatment on an unprecedented level.

Emphasizing the dire need for quick and efficient research and treatment of TBI/PTS was Sergeant First Class Victor L. Medina and his wife, Roxana Delgado, who gave a touching account of his experiences dealing with this critical issue facing our returning veterans.

“During the past year, we have made enormous strides in building our team of partners to take on this emerging national and international challenge,” stated One Mind CEO General Peter W. Chiarelli, U.S. Army (Retired). “This conference brings together an international coalition of renowned neuroscientists, policy makers and advocates, all striving to end brain-related illnesses in our lifetime.”

“The United States is facing a growing burden as a result of brain diseases,” added Garen Staglin, co-founder of One Mind for Research. “At this 1st annual conference we have reported on our progress toward cures and presented for the first time an independent study of what it costs our country in economic terms. We hope our findings will stimulate new donors and investment for research.”

One Mind for Research defined the first global scientific roadmap required for curing diseases of the brain within 10 years at last year’s launch conference held in Boston. From that roadmap, and in conjunction with its partners, One Mind is introducing a major program that address traumatic brain injury (TBI) and post-traumatic stress (PTS) that will be the first of many aimed at One Mind’s vision of a world free of brain disease. These efforts are prototype programs to dramatically improve treatments for TBI and PTS patients while also establishing broad collaborations within the neuroscience community.  Other projects are underway for Multiple Sclerosis (MS) and Alzheimer’s disease.

For more information on One Mind for Research, and the 1st Annual Meeting of the One Mind for Research Campaign: Curing Brain Disease, please visit www.1mind4research.org.

About One Mind for Research
One Mind for Research is an independent, non-profit organization that is committed to curing diseases of the brain and eliminating the stigma and discrimination they cause. Through collaboration with partners in science, advocacy and corporations, One Mind for Research is working to advance a 10-year plan to cure the diseases of the brain by creating change in the way scientists, health care professionals, NGO and government partners think about and conduct scientific and translational research, and by advancing mental health related public policy.

About Brain Disease
Brain diseases are the number 1 cause of adult disability globally, afflicting, in some form, 1 out of every 3 people. For example, among the psychiatric diseases (i.e. mental illnesses), major depressive disorder leads in prevalence, disabling about 5% of the population to some degree in any given year. Among veterans returning stateside from service in Iraq, 300,000 are estimated to have TBI and/or PTS, adding to the total estimate of 1.5 million Americans living with these diseases. Beyond the emotional pain endured by these individuals and their families, the total lifetime treatment cost for these individuals calculates to about $3.3 trillion. This and the cost of dementia care for our nations’ growing elder population ($400 billion annually now, to triple by 2050) will soon prove beyond the ability of the U.S. economy to sustain—unless neuroscience starts an emergency pace, right now. At a time of decreasing government research funding and pharmaceutical industry’s widespread withdrawal from psychiatric drug R&D, this cause needs public support now to develop the preventions and cures that will protect the brain health of people worldwide.


Media Contact:
Fuller & Sander Communications
Tom Fuller, 707-253-0868
tom@fullerandsander.com,
Monty Sander, 707-253-8503
monty@fullerandsander.com

Congratulations to Lisa Kantor

The Eating Disorders Coalition extends our deepest gratitude to Lisa Kantor and her team for fighting this battle until justice was served! On behalf of all those affected by eating disorders, we thank you and congratulate you on this victory!

Kantor & Kantor, LLP Announces Ruling That Health Plans Must Cover Residential Treatment for Eating Disorders

Ninth Circuit Decision Clarifies Insurer Obligations Under California Mental Health Parity Act

 

 

LOS ANGELES, June 5, 2012 /PRNewswire via COMTEX/ 

Kantor & Kantor, LLP announced today that the Ninth U.S. Circuit Court of Appeals has denied an insurer's request for rehearing of a significant victory for people suffering from nine enumerated mental health conditions - eating disorders in particular. The Court confirmed its August 26, 2011 decision that the California Mental Health Parity Act requires health plans to provide coverage of "all medically necessary treatment" for "severe mental illnesses" under "the same financial terms as those applied to physical illnesses." In the latest decision, Harlick v. Blue Shield of California, the court held that health plans in California are obligated to pay for residential treatment for people with eating disorders even if the policy excludes residential treatment.

"We appreciate that the Court not only denied Blue Shield's request for rehearing and rehearing en banc but also issued a new opinion with added clarity about the broad scope of California's Mental Health Parity Act," said Lisa Kantor of Kantor & Kantor, LLP, who represents the plaintiff Jeanene Harlick. "The majority opinion takes a common sense approach in interpreting the Act and accomplishes the legislative purpose of mandating full coverage for severe mental illnesses."

Jeanene Harlick has suffered from anorexia for more than 20 years. In 2006, her physicians recommended treatment at a facility qualified to treat eating disorders. Although Blue Shield agreed to pay for the treatment, after 10 days it denied coverage, saying the plan did not cover residential treatment even though the insurer agreed the treatment was medically necessary

In July 2008, Kantor sued Blue Shield on Harlick's behalf, arguing among other things, that Blue Shield's health plan violated the California Mental Health Parity Act. Blue Shield argued that it had discretion to deny coverage, and the district court agreed. Harlick appealed, and the Ninth Circuit ruled in her favor. Blue Shield requested a rehearing and a rehearing en banc (before all judges of the Ninth Circuit). The briefing on these requests was completed in November 2011. The California Department of Insurance filed a Brief of Amicus Curiae (friend of the Court), opposing Blue Shield's requests and supporting Harlick's position. The Department of Managed Healthcare did not file a similar brief in the matter, despite its responsibility for regulating health care service plans in California. 

For more information about Lisa Kantor and legal assistance for eating disorders, follow this link: http://www.kantorlaw.net/Areas_of_Practice/Eating_Disorders.aspx . 

About Kantor & Kantor, LLP

Kantor & Kantor is one of the largest law firms in the country exclusively representing plaintiffs who have been denied insurance benefits under life, health, disability and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters, as well as the handling of Insurance Bad Faith matters. 

For more information, log on to www.kantorlaw.net , call (800) 446-7529, or follow the firm at www.californiainsurancelawyerblog.com .

SOURCE Kantor & Kantor, LLP

Copyright (C) 2012 PR Newswire. All rights reserved

EDC Succeeds! Co-Chair of the Congressional Eating Disorders Caucus Agrees to Cosponsor the FREED Act

The Eating Disorders Coalition just received word from Congresswoman Nita Lowey's office that she has added her name as a cosponsor to the Federal Response to Eliminate Eating Disorders Act (H.R. 1448). We appreciate Congresswoman Lowey's leadership on this issue as exemplified not only as the co-chair of the Eating Disorders Caucus but also through her proactive support on the most comprehensive eating disorders bill in the history of Congress.  Thank you!