Legislative Advocacy
Mental Health Parity Overview
Federal mental health parity laws (taken together from 1996 and 2008) require that certain insurers—when they choose to cover mental health and substance abuse services—must offer mental health and substance abuse coverage that is on par with the coverage the insurer provides for medical and surgical services. Specifically, this parity applies in the following areas: Annual and aggregate lifetime limits; Treatment limitations; Financial requirements and In-network and out-of-network covered benefits.
Mental health parity law applies to specific types of insurance plans. They include large fully- and self-insured health plans, Medicaid managed care plans and Children’s Health Insurance Program (CHIP) health plans.
Below is the April 12, 2012 editorial found in the Washington Post, by Pete Domenici, (co-creator of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, 2008)
Waiting for mental health parity
By Pete Domenici and Gordon H. Smith,
Every day across the United States, families struggle with the challenges of mental illness or substance abuse. The 68 million Americans with these issues include people of all income levels, all races and all political affiliations. Mental illness does not discriminate.
Often, the difference between being overwhelmed as a family or meeting the challenges head-on and making progress against the illness can be just one factor: access to meaningful health insurance. Even those who think they have quality health coverage can be overwhelmed when a loved one receives a diagnosis of mental illness or is a substance abuser. They discover that their health insurance does not cover needed services or that the out-of-pocket expenses are prohibitive and significantly more than what is charged for physical ailments.
In 2008, Congress passed and President George W. Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. This law, which garnered bipartisan support, requires that large group health plans and Medicaid managed-care plans provide coverage for mental or substance-use disorders on par with the coverage offered for physical ailments. But when any law is passed, the federal government must implement and enforce it to make its benefits and provisions a reality.
President Obama voted for the bill as a U.S. senator, and all indications are that he remains supportive. Yet regulatory action has stalled since 2010. The final rule that would provide clarity to the millions who have a mental illness or substance-use disorder, and to their employers, has not been issued. This has created uncertainty and confusion for employers over what they must cover and when parity applies.
For example, many health insurance plans still refuse to cover lifesaving treatment for eating disorders. Others create discriminatory barriers to care, such as imposing stricter prior-authorization requirements for mental health and addiction treatment than for medical benefits. Sadly, as underscored in a recent report by the assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services, levels of care for evidence-based behavioral treatments, such as residential psychiatric services for children, are being eliminated because of uncertainty about what is required.
The most recent National Survey on Drug Use and Health, published last year, found that fewer than half of the 45.9 million adults with a mental illness receive treatment or counseling and that only 10 percent of the more than 23 million people who need help for a substance-use problem received any specialized treatment in 2010. Even more troubling is the fact that people with either disease have shorter life expectancies than most Americans; a 2006 study put the difference at 25 years.
The Obama administration should issue its final regulations to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. Doing so would allow employers to plan with certainty and stability — and would let families know that help will be there when they need it.
Link to a primer on mental health financing from Kaiser Family Foundation: http://www.kff.org/medicaid/
Link to the American Psychological Association’s parity page, which contains numerous resources and links: http://www.apapracticecentral.
How the Affordable Care Act Impacts Parity
The Patient Protection and Affordable Care Act (ACA)—the comprehensive health care overhaul signed into law by President Obama on March 23, 2010—impacts federal mental health parity law in several ways. While it does not change federal mental health coverage requirements, it does require that additional types of health insurance plans to be in compliance with parity law. These plans include:
· Qualified Health Plans (QHPs) that will be offered through state-based insurance exchanges (the insurance marketplaces that are being established by the ACA to assist individuals and employers with the purchase of health insurance);
· Health insurance plans offered via the individual market; and
· Medicaid benchmark (and benchmark equivalent) plans that are not managed care plans.
In addition to expanding what types of health plans must comply with parity law, the ACA also affects coverage of mental health and substance abuse services via its Essential Health Benefits (EHB) package. QHPs offered via the exchanges will be required to offer a minimum package of benefits, referred to as the EHB package. Additionally, all new plans offered via the small group market and individual market must comply, as must Medicaid benchmark and benchmark equivalent plans.
Specifically, there will be 10 categories of services/items that must be included in an EHB, one of which is a category for mental health and substance abuse services, which includes behavioral health treatment. The Department of Health and Human Services is in the process of setting EHB rules and appears to be leaning toward an approach that offers significant state flexibility in determining the specifics of an EHB package, based on a bulletin it released in late 2011.
Link to a summary of the law: http://www.kff.org/
Link on how the law affects Medicaid and CHIP: http://www.kff.org/
Link to summary of coverage provisions: http://www.kff.org/
Additional resources: http://www.kff.org/
EDC Applauds the Creation of a Federal Bi-Partisan Caucus Addressing Eating Disorders
WASHINGTON, D.C. Feb. 28, 2012 — The Eating Disorders Coalition (EDC) applauds Congress for establishing the National Eating Disorders Awareness Caucus. In a bipartisan effort Congresswomen Nan Hayworth (R-NY-19) and Nita Lowey (D-NY-18) are co-chairs of the Caucus. ”Their support underscores the fact that eating disorders impact Americans of all races and genders, young and old, Republicans and Democrats” said Lisa Lilenfeld Ph.D., President of the Eating Disorders Coalition.
The Eating Disorders Coalition will work with the Caucus in order to continue advancing the Federal recognition of eating disorders as a public health priority. Jeanine Cogan Ph.D., Policy Director of the EDC said, “We are thrilled that Members of Congress expressed their interest in forming a caucus specifically to address eating disorders. In forming the Caucus, Congress is showing their active commitment to bring attention to the devastation caused by eating disorders and come up with important policy solutions.” The caucus will help us further advance the Federal Response to Eliminate Eating Disorders Act (FREED Act), which is the first ever comprehensive bill to address eating disorders treatment, research, education and prevention. Congresswoman Lowey has been a supporter of the FREED Act and it sends an important message that Congresswoman Hayworth, the only female physician in Congress, is taking a leadership role in addressing eating disorders.
The Eating Disorders Coalition has provided a voice on Capitol Hill for the individuals who suffer, families, treatment providers, researchers and over 35 Member Organizations since 2000. We developed relationships with Members of Congress through our bi-annual National Eating Disorders Lobby Days. The EDC worked with Members of Congress to introduce the FREED Act, which will provide access to treatment by addressing the current and disparate lack of insurance coverage most sufferers of eating disorders face.
For more information, please contact the Eating Disorders Coalition at 202-543-9570 or manager@
Several pieces of federal legislation relating to eating disorders have been introduced in the 112th Congress. With a focus on improved insurance coverage, research and education for eating disorders, these pieces of legislation are an important part of ANAD’s federal advocacy strategy.
Details on the bills are as follows:
H.R. 36 — The Eating Disorders Awareness, Prevention, and Education Act of 2011
Congresswoman Judy Biggert (R-IL) — ANAD’s hometown federal Representative — introduced H.R. 36 in January 2011. The legislation, known as the Eating Disorders Awareness, Prevention, and Education Act of 2011, seeks to amend education law to authorize the use of funds for programs to improve identification of students with eating disorders, increase awareness of eating disorders among parents and students and train educators with respect to effective eating disorder prevention and assistance methods. Additionally, H.R. 36 would require a national study on the impact eating disorders have on educational advancement and achievement and would require a report on current state and local programs to educate youth on the dangers of eating disorders.
The legislation was referred to both the House Committee on Energy and Commerce and the House Committee on Education and the Workforce, where it awaits further consideration before each committee.
The full text and summary of the Disorders Awareness, Prevention, and Education Act can be found here. Please paste into your browser, as these links expire after inactivity:
http://thomas.loc.gov/cgi-bin/
Congresswoman Biggert released the following statement upon the introduction of H.R. 36:
http://biggert.house.gov/
Additionally, the Congresswoman further highlighted the legislation in a detailed press release following site visit to Linden Oaks behavioral health center at Edward Hospital (IL):
http://biggert.house.gov/
S. 481 and H.R. 1448 — The Federal Response to Eliminate Eating Disorders (FREED) Act
The Federal Response to Eliminate Eating Disorders (FREED) Act was introduced by Senators Tom Harkin (D-IA), Amy Klobuchar (D-MN) and Al Franken (D-MN) in March 2011 (S. 481), and its House counterpart was introduced by Congresswoman Tammy Baldwin (D-WI) in April 2011 (H.R. 1448). The two identical bills are a comprehensive effort to improve research, treatment, education and prevention of eating disorders. Among its many provisions, the FREED Act would: award grants for training and education programs to teach clinical skills pertinent to identifying and treating eating disorders; increase research and awareness efforts at the Department of Health and Human Services (HHS), National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC); expand Medicaid coverage for eating disorders; and provide for public service announcements on eating disorders.
The FREED Act currently awaits consideration at the committee level — it has been referred to the Health, Education Labor and Pensions (HELP) Committee in the Senate and four different committees in the House (Energy and Commerce, Ways and Means, Education and the Workforce and Oversight and Government Reform).
The full text and summary of the FREED Act can be found here. Please paste into your browser, as these links expire after inactivity:
http://thomas.loc.gov/cgi-bin/
Senator Harkin released the following statement upon introduction of the FREED Act:
http://harkin.senate.gov/
Additionally, the Eating Disorders Coalition — of which ANAD is a participating member organization — has compiled the following materials on the FREED Act:
http://www.
http://www.
Lobby Day Success!
Lobby Day Reception: The Lobby Day reception was a wonderful chance to demonstrate ANAD’s support for the Eating Disorders Coalition and the Federal Response to Eliminate Eating Disorders (FREED) Act. Elizabeth Isbey attended the Lobby Day Reception for the FREED Act lobby activities, where she met with several members of the Eating Disorders to discuss efforts in Washington to promote the bill. In addition, Elizabeth talked with several providers from partial hospitalization and outpatient programs, and was inspired by their stories and their commitment to addressing eating disorders through the FREED Act. It was a special opportunity to join together, and we are thrilled that ANAD could be there to lend its support to the FREED Act.
IMAGE: McDermott Will & Emery, ANAD’s pro bono counsel in Washington, DC was proud to represent ANAD at the Eating Disorders Coalition Lobby Day on Capitol Hill October 4, 2011. Among those pictured here (from left) are Marissa McKeever with ANAD Washington Counsel McDermott Will & Emery; Stacey Brown and LoRene Hernandez from Avalon Hills Treatment Center in Utah ; and Joel Case and his daughter McKenzie from Idaho (they came to Washington to celebrate her recovery), along with other advocates.
Lobby Day Activities: Lobby Day activities included a welcome reception, an orientation, message training, visits with the offices of members of Congress and a briefing for congressional staff. The briefing, held in the Capitol Visitors Center, featured a panel of advocates as well as Congresswoman Tammy Baldwin, Democrat of Wisconsin. Rep. Baldwin is the lead sponsor of the FREED Act in the House of Representatives. She spoke forcefully about the need to increase support for the FREED Act and commented about the compelling personal stories that EDC advocates had shared with her. The FREED Act is the first eating disorders legislation to comprehensively promote research, treatment, education and prevention programs. The legislation, S. 481, entitled “The Federal Response to Eliminate Eating Disorders Act,” was introduced in the U.S. Senate by Senator Tom Harkin, Democrat of Iowa. As noted above, the House companion version, HR 1448, was introduced by Congresswoman Tammy Baldwin, Democrat of Wisconsin.
The EDC Lobby Day was a wonderful opportunity to educate Members of Congress and staff about eating disorders and urge support for the FREED Act. The EDC organizes two lobby days each year, one in the spring and one in the fall. ANAD’s Washington Counsel McDermott Will & Emery has participated in both the April 2011 and the November 2011 EDC Lobby Days.
Karen Sealander and Elizabeth Isbey of McDermott Will & Emery LLP recently represented ANAD at the Eating Disorders Coalition (EDC) National Lobby Day on Capitol Hill (April 11-12). ANAD’s representatives and the other advocates took the opportunity to educate legislators and staff about eating disorders. The advocates urged support for the Federal Response to Eliminate Eating Disorders (the FREED Act), S. 481 in the Senate and HR 1448 in the House of Representatives. The FREED Act would provide Federal funding for treatment, research, education, and prevention initiatives related to eating disorders. The Lobby Day was a great success and ANAD was excited to be part of such an important event for the eating disorders community.
Federal Legislation
Active Bills
Follow bills proposed at the national level to provide improved insurance coverage, research, education, and more for eating disorders. Find your representative and encourage him or her to support a proposed bill that needs to pass, or introduce a new bill. Let your voice be heard.
State Legislation
Active Bills
Follow bills proposed in your state to provide improved insurance coverage, research, education and more for eating disorders. Find your representative and encourage him or her to support a proposed bill that needs to pass, or introduce a new bill. Let your voice be heard.
California
Assembly Bill 154
Connecticut
Senate Bill 877
Illinois
House Bill 1530
Maryland
House Bill 570
Missouri
Senate Bill 229
New Jersey
Assembly Bill 3970
Senate Bill 948
North Dakota
Senate Bill 2354
Pennsylvania
Senate Bill 429
Texas
House Bill 1292
Virginia
Senate Joint 294
Legislative News
Two airbrushed ads banned in the UK
Two L’Oreal makeup advertisements featuring actor Julia Roberts and supermodel Christy Turlington have been banned in the UK. According to the Advertising Standards Agency (ASA), a British watchdog agency, the ads had undergone significant airbrushing, to the point that, “We could not conclude that the ad image accurately illustrated what effect the product could achieve, and that the image had not been exaggerated by digital post production techniques.” While L’Oreal protested the ban, they admitted to retouching the ads.
Scottish Member of Parliament, Jo Swinson, originally pushed for a ban of these ads, saying, “Pictures of flawless skin and super-slim bodies are all around, but they don’t reflect reality. With one in four people feeling depressed about their body, it’s time to consider how these idealized images are distorting our idea of beauty.”
The ASA’s response represents one of the few cases where advertising is being regulated to protect consumers from false and misleading advertisements. ANAD encourages U.S. consumers to demand more realistic images from advertisers. Take a moment to contact your representative and ask them how the United States can take action in protecting citizens from false and harmful images and advertising.