Legislative News Archives

Report from Act 129 representative Scott Earisman:

I am finally getting more grounded in the Act 129 meeting process. Briefly, this is where Vt. Dept. of Banking, Insurance, Securities, and Healthcare Administration (BISHCA) puts in to legislative processes the rules governing managed care, healthcare, and oversight. The most relevant topics center around consumer protections regarding access to care, coverage for emergency services, and protection and appeals processes for denial of care issues.

As far as I can determine, however, protection for providers (you and me, for example) has a very limited invitation to be heard. Reimbursement rates are clearly "off the table," and the insurance company representatives react angrily when we try to discuss opening up billing code option so that quality care can be fully reimbursed. Examples would include reimbursement for crisis contact by telephone, extended family and group sessions, and case management services for complex cases. To be fair, some companies are better than others in covering some of this. The point is that there is resistance to discussing how to remove these barriers to treatment in this meeting.

Overall, the providers who attend these meeting have pushed Vermont to the front nationally in creating progressive mental healthcare policy, and so I walk in the footprints of some giants, like Alex Forbes and Don Rhodes. And believe me, it is hard to sit in a room with eight Cigna representatives, lawyers representing the healthcare organization, and people who admit that it is their job to attend meeting such as this and protect company interests, and to still be heard and make a difference.

All of you can help, simply by communicating to state legislators and to BISHCA whenever healthcare organization policies seem to be discriminatory, or to present barriers to clients in receiving quality care. And remember that you can frame the education and assistance you provide to your clients as they advocate for themselves in terms of empowerment and self-reliance.

Thank you,
Scott Earisman, LCMHC, LADC

A Note of Thanks from VTMHCA President
I want to publically extend a big “Thank You!” to Scott for his willingness to take on this essential role of our Act 129 Representative, representing our discipline, and mental health and substance abuse client-consumers. The number of meetings around new legislation has dramatically increased and Scott has been there, working tirelessly. Scott, I am not only personally grateful, but professionally proud to have you as a colleague.

Sincerely, Heather Pierce, MA, LCMHC
President, VTMHCA

The New York Times
October 6, 2008

Bailout Provides More Mental Health Coverage

By ROBERT PEAR

WASHINGTON — More than one-third of all Americans will soon receive better insurance coverage for mental health treatments because of a new law that, for the first time, requires equal coverage of mental and physical illnesses.

The requirement, included in the economic bailout bill that President Bush signed on Friday, is the result of 12 years of passionate advocacy by friends and relatives of people with mental illness and addiction disorders. They described the new law as a milestone in the quest for civil rights, an effort to end insurance discrimination and to reduce the stigma of mental illness.

Most employers and group health plans provide less coverage for mental health care than for the treatment of physical conditions like cancer, heart disease or broken bones. They will need to adjust their benefits to comply with the new law, which requires equivalence, or parity, in the coverage.

For decades, insurers have set higher co-payments and deductibles and stricter limits on treatment for addiction and mental illnesses.

By wiping away such restrictions, doctors said, the new law will make it easier for people to obtain treatment for a wide range of conditions, including depression, autism, schizophrenia, eating disorders and alcohol and drug abuse.

Frank B. McArdle, a health policy expert at Hewitt Associates, a benefits consulting firm, said the law would force sweeping changes in the workplace.

“A large majority of health plans currently have limits on hospital inpatient days and outpatient visits for mental health treatments, but not for other treatments,” Mr. McArdle said. “They will have to change their plan design.”

Federal officials said the law would improve coverage for 113 million people, including 82 million in employer-sponsored plans that are not subject to state regulation. The effective date, for most health plans, will be Jan. 1, 2010.

The Congressional Budget Office estimates that the new requirement will increase premiums by an average of about two-tenths of 1 percent. Businesses with 50 or fewer employees are exempt.

The goal of mental health parity once seemed politically unrealistic but gained widespread support for several reasons:

  • Researchers have found biological causes and effective treatments for numerous mental illnesses.
  • A number of companies now specialize in managing mental health benefits, making the costs to insurers and employers more affordable. The law allows these companies to continue managing benefits.
  • Employers have found that productivity tends to increase after workers are treated for mental illnesses and drug or alcohol dependence. Such treatments can reduce the number of lost work days.
  • The stigma of mental illness may have faded as people see members of the armed forces returning from Iraq and Afghanistan with serious mental problems.
  • Parity has proved workable when tried at the state level and in the health insurance program for federal employees, including members of Congress.

Dr. Steven E. Hyman, a former director of the National Institute of Mental Health, said it was impossible to justify insurance discrimination when an overwhelming body of scientific evidence showed that “mental illnesses represent real diseases of the brain.”

“Genetic mutations and unlucky combinations of normal genes contribute to the risk of autism and schizophrenia,” Dr. Hyman said. “There is also strong evidence that people with schizophrenia have thinning of the gray matter in parts of the brain that permit us to control our thoughts and behavior.”

The drive for mental health parity was led by Senator Pete V. Domenici, Republican of New Mexico, who has a daughter with schizophrenia, and Senator Paul Wellstone, the Minnesota Democrat who was killed in a plane crash in 2002. Mr. Wellstone had a brother with severe mental illness.

Prominent members of both parties, including Betty Ford, Rosalynn Carter and Tipper Gore, pleaded with Congress to pass the legislation.

Representatives Patrick J. Kennedy, Democrat of Rhode Island, and Jim Ramstad, Republican of Minnesota, led the fight in the House. Mr. Kennedy has been treated for depression and, by his own account, became “the public face of alcoholism and addiction” after a car crash on Capitol Hill in 2006. Mr. Ramstad traces his zeal to the day in 1981 when he woke up in a jail cell in South Dakota after an alcoholic blackout.

The Senate passed a mental health parity bill in September 2007. The House passed a different version in March of this year.

A breakthrough occurred when sponsors of the House bill agreed to drop a provision that required insurers to cover treatment for any condition listed in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.

Employers objected to such a requirement, saying it would have severely limited their discretion over what benefits to provide. Among the conditions in the manual, critics noted, are caffeine intoxication and sleep disorders resulting from jet lag.

Doctors often complain that insurers, especially managed care companies, interfere in their treatment decisions. But doctors and mental health advocates cited the work of such companies in arguing that mental health parity would be affordable, because the benefits could be managed.

Pamela B. Greenberg, president of the Association for Behavioral Health and Wellness, a trade group, said providers of mental health care typically drafted a treatment plan for each person. In complex cases, she said, a case manager or care coordinator monitors the patient’s progress.

A managed care company can refuse to pay for care, on the grounds that it is not medically necessary or “clinically appropriate.” But under the new law, insurers must disclose their criteria for determining medical necessity, as well as the reason for denying any particular claim for mental health services.

Andrew Sperling, a lobbyist at the National Alliance on Mental Illness, an advocacy group, said, “Under the new law, we will probably see more aggressive management of mental health benefits because insurers can no longer impose arbitrary limits.”

The law will also encourage insurers to integrate coverage for mental health care with medical and surgical benefits. Under the law, insurers cannot have separate cost-sharing requirements or treatment limits that apply only to mental illness and addiction disorders.

The law comes just three months after Congress eliminated discriminatory co-payments in Medicare, the program for people who are 65 and older or disabled.

Medicare beneficiaries pay 20 percent of the government-approved amount for most doctors’ services but 50 percent for outpatient mental health services. The co-payment for mental health care will be gradually reduced to 20 percent over six years.

The mental health parity law was forged in a highly unusual consensus-building process. For years, mental health advocates had been lobbying on the issue.

Insurers and employers, which had resisted earlier versions of the legislation, came to the table in 2004 at the request of Mr. Domenici and Senators Edward M. Kennedy, Democrat of Massachusetts, and Michael B. Enzi, Republican of Wyoming.

Each side had, in effect, a veto over the language of any bill. Insurers and employers, seeing broad bipartisan support for the goal in both houses of Congress, decided to work with mental health advocates. Each side gained the other’s trust.

“It was an incredible process,” said E. Neil Trautwein, a vice president of the National Retail Federation, a trade group. “We built the bill piece by piece from the ground up. It’s a good harbinger for future efforts on health care reform.”

E-News from Washington
October 6, 2008

AMHCA Applauds Enactment of Mental Health Parity and Addiction Equity Act

Alexandria, Va., October 6, 2008 – By a vote of 263 to 171, the U.S. House of Representatives, on October 3, 2008, gave final approval to the Paul Wellstone-Pete Domenici Mental Health Parity and Addiction Equity Act, as part of the Emergency Stabilization Act (H.R. 1424). President George W. Bush signed the legislation into law several hours later.

The American Mental Health Counselors Association (AMHCA) applauds the 110th Congress for including the mental health and substance abuse parity language in the economic rescue legislation, and the President for signing this legislation into law. Enactment of the bill ends nearly a decade long effort to require group health plans to cover treatment for mental illness on the same terms and conditions as for all other illnesses.

“AMHCA commends the 110th Congress, particularly sponsors of the parity legislation, Sens. Pete Domenici (R-NM) and Edward Kennedy (D-MA) and Reps. Patrick Kennedy (D-RI) and Jim Ramstad (R-MN), for their tireless efforts to ensure that this legislation was enacted during the remaining hours of the 110th Congress, said AMHCA President Victoria A. Sardi, Ph.D., LPC. As a result of this legislation, Americans who suffer from mental and addiction disorders will now have greater access to the services they need to live more productive and meaningful lives.”

AMHCA also appreciates its members, as well as other mental health and addiction advocates from across the country, who contacted their Senators and House members to push for consideration of this legislation. Without their advocacy on this issue, we would not have seen the ultimate enactment of this landmark bill during the 110th Congress.

 

E-News from Washington
Vol. 08-30
August 1, 2008

Mental Health Services Should Be More Accessible in Primary Care Settings

A multi-agency report released on July 23, 2008, proposes strategies to overcome barriers associated with the reimbursement of mental health services provided in primary care settings, and recommends that non-physician practitioners under Medicare and Medicaid be reimbursed, particularly in underserved and urban areas.

The report was issued by the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA), and the Centers for Medicare & Medicaid Services (CMS), three agencies within the Department of Health and Human Services.

“The actions identified in this study are practical as well as achievable,” said Terry Cline, Ph.D., administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA). “Improving access to timely and targeted mental health services in primary care settings can improve patient health and compliance with treatment.”

Mental health service consumers, practitioners, providers, researchers and government officials have identified seven barriers and made suggestions for action aimed at alleviating the barriers to the reimbursement of mental health services in the primary care setting.

The main priorities and actions recommended in the conclusions of the report, Reimbursement of Mental Health Services in Primary Care, include the following:

  • Increase leadership collaboration at the federal and state levels among government policymakers in Medicare, Medicaid, primary care, and mental health to ensure clarity in policies, rules, and procedures, and to promote the provision and reimbursement of mental health services in primary care settings;
  • Broadly disseminate clarified policies and procedures to patients, payers, practitioners, providers, and managers of care;
  • Provide technical assistance and education to states, practitioners, providers, and managed care organizations;
  • Encourage flexibility in state Medicaid benefit designs to cover mental health services in primary care settings, modeling changes based on best practices achieved through existing state Medicaid waivers;
  • Increase payment for professional services by non-physician practitioners under Medicare and Medicaid, particularly in underserved rural and urban areas;*
  • Implement policies at the state level for appropriate reimbursement of telemedicine services; and,
  • Provide reimbursement for mental health prevention and screening services.

*The report provides information about the reimbursement status of professional counselors under Medicare and the report recommends that non-physician practitioners under Medicare and Medicaid be reimbursed, particularly in underserved and urban areas.

The full report is available on the Web at http://download.ncadi.samhsa.gov/ken/pdf/SMA08-4324/SMA08-4324.pdf.

E-News from Washington

Vol. 06-28
June 21, 2006

Mental Health Counselors included in New Rural Health Care Legislation

The American Mental Health Counselors Association (AMHCA) and the American Counseling Association’s (ACA) effort to gain Medicare reimbursement for state-licensed mental health counselors took one step further on June 13, 2006, with the introduction of S. 3500, the Rural Hospital and Provider Equity (R-HoPE) Act of 2006.

S. 3500 was introduced by a bipartisan group of Senate Rural Health Caucus members, of which Thomas and Sen. Kent Conrad (D-SD) serve as co-chairs. The legislation was referred to the Senate Finance Committee. The R-HoPE Act brings to five the total number of proposals under which mental health counselors could bill Medicare.

In addition to S. 3500, bipartisan legislation is pending in the Senate (S. 784), also introduced by Sen. Thomas and his Finance Committee colleague, Sen. Blanche Lincoln (D-AR), to reimburse mental health counselors under Medicare. In addition, in May 2006, Rep. Barbara Cubin introduced a House companion bill (H.R. 5324) to S. 784. The Medicare Mental Health Modernization Act (H.R. 1946)/(S. 927) that would, among other things, allow mental health counselors to provide mental health services to Medicare beneficiaries is also pending.

In addition to allowing LMHCs to bill Medicare, S. 3500 would adjust Medicare payments to rural hospitals and make a series of changes to boost funding for rural clinics, doctors and ambulances. Many of the provisions extend or alter rural health care provisions that were included in the Medicare Modernization Act passed three years ago.

Although the legislation’s primary focus is on rural health care, S. 3500 would allow mental health counselors and marriage and family therapists to be reimbursed in all areas of the country.

ACTION NEEDED

Call your Senators and ask them to cosponsor and support both S. 3500, the Rural Hospital and Provider Equity Act, sponsored by Sens. Craig Thomas (R-WY) and Kent Conrad (D-SD) and the Seniors Mental Health Access Improvement Act (S. 784).

TARGETS

Members of the U.S. Senate, especially members of the Finance Committee. To find out of your Senator is a member of the Finance committee, visit the committee website at http://finance.senate.gov/. If you don’t know the name of your Senators, visit the website for the U.S. Senate at www.senate.gov. The U.S. Capitol switchboard can be reached at 202-224-3121.

SAMPLE MESSAGE

“As a constituent, I am calling to ask the Senator to cosponsor and support two bills that would allow state-licensed mental health counselors to provide mental health services to Medicare beneficiaries. S. 3500, the Rural Hospital and Provider Equity Act, and S. 784, the Seniors Mental Health Care Access Improvement Act would provide better access to mental health care for our nation’s growing number of senior citizens. Access to providers is especially difficult in rural and underserved areas, and mental health counselors are often the only mental health provider available”.

AMHCA and ACA will continue to meet with members of the Senate to increase support for this legislation. If you have any questions or need additional information, please feel free to contact Beth Powell at AMHCA at 800-326-2642, ext. 105 or by e-mail at bpowell@amhca.org. Brian Altman at ACA can be reached at 800-347-6647, ext. 242, or by e-mail at baltman@counseling.org


E-News from Washington

Vol. 06-27
June 09, 2006

Children of Depressed Parents Have More Health Problems

The adult offspring of depressed parents are far more likely than those of non-depressed parents to have psychiatric and medical problems, such as cardiovascular disease, according to a study reported in the June American Journal of Psychiatry.

The study found that the rates of anxiety disorders, major depression, and substance use disorders were about three times that of offspring from non-depressed parents 20 years after a baseline survey. In addition, adult children of depressed parents had about five times the rate of cardiovascular illness as children of non-depressed parents. The study’s lead author and investigator Myrna Weissman, Ph.D., is a professor of epidemiology in psychiatry at the College of Physicians and Surgeons and the School of Public Health at Columbia University. She first began following her sample of 151 children from depressed and non-depressed parents in 1982 in their homes in New Haven, Conn.

Some of her samples were drawn from the offspring of depressed adults receiving outpatient depression treatment at Yale University's depression research unit in the early 1980s. According to the study, the adults who volunteered their children to be studied were moderately to severely depressed. She also recruited children of non-depressed parents who participated in the Epidemiologic Catchment Area study.

Dr. Weissman assessed 220 offspring aged 6 to 23 in both groups at baseline and then at two years, 10 years, and 20 years later. By the 20-year follow-up evaluation, there were 101 offspring with one or more parents with depression and 50 offspring with parents with no depression.

To screen the offspring, researchers used the Schedule for Affective Disorders and Schizophrenia-Lifetime Version, the Global Assessment Scale, and the Social Adjustment Scale-Self Report. Researchers also used a standard medical checklist to gather information on non-psychiatric medical conditions.

Twenty years after she first studied them, Weissman found that the offspring of depressed parents had higher rates of major depression over the two decades (65 percent) compared with offspring of non-depressed parents (27 percent) in her sample. Compared with their peers, children of depressed parents had about three times the risk of developing depression by the time they were adults. In addition, while just 15 percent of offspring of non-depressed parents had a phobia, 43 percent of offspring of depressed parents did, which meant they had three times the risk for developing a phobia by the time they were adults.

The study noted that "peak of first onset [of psychiatric disorders] was before the age of 20, with anxiety disorders before puberty and with major depression and substance dependence after puberty." Twice as many of the offspring of depressed parents (19 percent) developed an addiction to drugs or alcohol, as did those of non-depressed parents (8 percent), putting them at more than twice the risk of developing a substance use disorder. Offspring of depressed parents also had more medical problems than their counterparts.

The study found that by the 20-year evaluation, 11 percent of offspring of depressed parents had developed cardiovascular disease, compared with only 2 percent of children of non-depressed parents, making the former about five times as likely to develop heart problems as adults. Offspring of depressed parents were also more than twice as likely to develop a neuromuscular disorder.

Dr. Weissman cited a number of studies that found an association between depression and cardiovascular illness and said that an association between the two conditions could stem from altered immune, platelet, and hypothalamic-pituitary-adrenal axis functioning in depressed patients.

She said that neither parents nor children with depression should be considered in isolation of one another. "If clinicians see a child with a psychiatric illness, they should examine the parents and see if one or both are depressed," Weissman said, and do the same for depressed adult patients who have children. "Parents and children should be considered a package."