By Ben Hartman
Contributing Writer, MedPage Today
Originally published February 7, 2014
Demand -- for both facilities and providers -- has long outpaced supply in the field of mental health, but recent moves to increase funding for mental health services combined with innovative delivery systems may reverse that trend.
(cut)
But money is not the only issue: many PCPs lack the needed psychiatric training, according to Jaseu Han, MD, residency director of the combined family medicine/psychiatry program at the University of California Davis Health System.
"There has to be a behavioral component to all residencies. There is a ton of talk about the value of patient-physician interactions, but the residents are not receiving psychiatric training. If you look at internal medicine, Ob/Gyn, pediatrics, and family medicine, they don't get anything. There is no requirement during residency to get any mental health experience."
The entire story is here.
Editorial note: This article points out another reason psychologists with advanced training and supervision in psychopharmacology can bridge the gap as prescribing psychologists.
Please listen the Psychologists and Prescriptive Authority: Where are we now? podcast
Showing posts with label Mental Health Parity. Show all posts
Showing posts with label Mental Health Parity. Show all posts
Tuesday, February 25, 2014
Friday, October 11, 2013
Lacking Rules, Insurers Balk at Paying for Intensive Psychiatric Care
By REED ABELSON
The New York Times
Published: September 27, 2013
Here is an excerpt:
Melissa’s treatment did not come cheap: it ultimately cost hundreds of thousands of dollars, Ms. Morelli said. Patients often find themselves at odds with health insurers, but the battles are perhaps nowhere so heated as with the treatment of serious mental illness.
It was not supposed to be this way. A federal law, the Mental Health Parity and Addiction Equity Act of 2008, was aimed at avoiding fights like this over coverage by making sure insurers would cover mental illnesses just as they cover treatment for diseases like cancer or multiple sclerosis.
The entire story is here.
The New York Times
Published: September 27, 2013
Here is an excerpt:
Melissa’s treatment did not come cheap: it ultimately cost hundreds of thousands of dollars, Ms. Morelli said. Patients often find themselves at odds with health insurers, but the battles are perhaps nowhere so heated as with the treatment of serious mental illness.
It was not supposed to be this way. A federal law, the Mental Health Parity and Addiction Equity Act of 2008, was aimed at avoiding fights like this over coverage by making sure insurers would cover mental illnesses just as they cover treatment for diseases like cancer or multiple sclerosis.
The entire story is here.
Monday, July 29, 2013
Connecticut Mental Health Lawsuit Takes Insurers To Task
High Co-pays and issue in High Profile Case
By JAY STAPLETON
Connecticut Law Tribune
Originally published July 12, 2013
A Connecticut law firm has taken the lead in a high-profile federal lawsuit that accuses a group of insurance companies of overcharging for mental health services, prompting thousands of vulnerable patients to avoid treatment.
In the American Psychiatric Association v. Anthem Health Plans lawsuit, the firm of Murtha Cullina was hired as chief legal counsel for the plaintiffs. Attorney Marie Pepe VanDerLaan of the firm's Hartford office, the lead lawyer in the case, filed the complaint on the APA's behalf in U.S. District Court in New Haven.
At the heart of the claim is that the insurance company manipulated billing statements in order to charge higher co-pays for patients being treated for mental disorders than those required for patients with physical ailments. The APA is a lead plaintiff in the case, joined by psychologist Susan Savulak of Newington and several of her patients.
The entire article is here.
By JAY STAPLETON
Connecticut Law Tribune
Originally published July 12, 2013
A Connecticut law firm has taken the lead in a high-profile federal lawsuit that accuses a group of insurance companies of overcharging for mental health services, prompting thousands of vulnerable patients to avoid treatment.
In the American Psychiatric Association v. Anthem Health Plans lawsuit, the firm of Murtha Cullina was hired as chief legal counsel for the plaintiffs. Attorney Marie Pepe VanDerLaan of the firm's Hartford office, the lead lawyer in the case, filed the complaint on the APA's behalf in U.S. District Court in New Haven.
At the heart of the claim is that the insurance company manipulated billing statements in order to charge higher co-pays for patients being treated for mental disorders than those required for patients with physical ailments. The APA is a lead plaintiff in the case, joined by psychologist Susan Savulak of Newington and several of her patients.
The entire article is here.
Wednesday, May 15, 2013
One Step Forward On Mental Health Parity
The American Psychiatric Association
Press release on May 1, 2013
Yesterday, the United States District Court for the District of Vermont became the first court in the country to interpret the Mental Health Parity and Addiction Equity Act of 2008—and that decision is favorable to mental health patients.
In C. M. v. Fletcher Allen Health Care, Inc., plaintiff C. M. challenges her health plan’s administration of mental health benefits. Specifically, she alleges that the Plan violates MHPAEA by: (1) requiring pre-approval for routine mental health services but not for medical-surgical services; (2) conducting concurrent reviews of mental health services but not requiring such reviews for medical-surgical services; and (3) initiating automatic review processes triggered by a fixed number of visits for mental health services but not for medical-surgical services.
The defendant argued that the Interim Final Regulations under MHPEA require that, in addition to demonstrating that mental health services were treated in a different manner than medical-surgical services, patients have to demonstrate that “no clinically appropriate standard of care would permit a difference,” to prove violation of MHPAEA. The Court disagreed, finding that “the Parity Act was promulgated to eliminate impermissible disparity in the benefits afforded for mental health and substance abuse disorders when compared to those afforded medical/surgical conditions. ... It stands to reason that plan administrators would also bear the burden of establishing, under the Parity Act, why mental health and medical benefits are treated differently based upon divergent clinical standards.”
According to Colleen Coyle, General Counsel of the American Psychiatric Association, “this is significant because it clearly puts the burden on the insurance industry to provide clinically appropriate standards of care to justify treating mental health claims differently than medical-surgical claims. Mental health and substance disorder patients have a right to know whether they are being treated differently than patients with other physical or surgical issues, and if so, on what clinical grounds the insurance companies justify that difference.” The APA assisted the plaintiff’s counsel in briefing the MHPAEA arguments in this case, has filed another lawsuit against insurers Anthem and WellPoint, and is in the process of challenging several other insurance carriers it believes are violating mental health parity.
Lead attorney representing C.M., Alison J. Bell, partner at Langrock Sperry & Wool, LLP, said, “Mental health parity is an important lifeline for my client, who was denied benefits for medical care desperately needed in order to live a healthy life. We are grateful for the APA’s assistance with MHPAEA issues.”
Meiram Bendat, founder of Psych-Appeal, which assists mental health professionals and their patients in challenging insurance denials for mental health treatment, added “Psych-Appeal has worked hard to bring the parity issues to the forefront in this case and proudly hails its collaboration with plaintiff's counsel and the American Psychiatric Association."
Last weekend, former Congressman Patrick Kennedy held a round table discussion with psychiatrists, patients, mental health advocates, and political leaders about mental health parity, and the need for patients to speak out publicly about disparate treatment of mental health claims in order to ensure that the full vision of MHPAEA is realized. (Read one of the patient stories as previously provided in hearings held by the Connecticut Health Care Advocate’s office.) James Scully, CEO and Medical Director of the APA stated, “The APA applauds plaintiff C.M. and others who spoke at the round table last week for having the courage to stand up for the right to care. We look forward to the day when parity is fully realized and those with a mental illness and/or substance use disorders can expend their energy and resources conquering the illness, rather than battling the insurance companies for the coverage to which they are entitled and for which they and their employer have paid.”
The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.
Press release on May 1, 2013
Yesterday, the United States District Court for the District of Vermont became the first court in the country to interpret the Mental Health Parity and Addiction Equity Act of 2008—and that decision is favorable to mental health patients.
In C. M. v. Fletcher Allen Health Care, Inc., plaintiff C. M. challenges her health plan’s administration of mental health benefits. Specifically, she alleges that the Plan violates MHPAEA by: (1) requiring pre-approval for routine mental health services but not for medical-surgical services; (2) conducting concurrent reviews of mental health services but not requiring such reviews for medical-surgical services; and (3) initiating automatic review processes triggered by a fixed number of visits for mental health services but not for medical-surgical services.
The defendant argued that the Interim Final Regulations under MHPEA require that, in addition to demonstrating that mental health services were treated in a different manner than medical-surgical services, patients have to demonstrate that “no clinically appropriate standard of care would permit a difference,” to prove violation of MHPAEA. The Court disagreed, finding that “the Parity Act was promulgated to eliminate impermissible disparity in the benefits afforded for mental health and substance abuse disorders when compared to those afforded medical/surgical conditions. ... It stands to reason that plan administrators would also bear the burden of establishing, under the Parity Act, why mental health and medical benefits are treated differently based upon divergent clinical standards.”
According to Colleen Coyle, General Counsel of the American Psychiatric Association, “this is significant because it clearly puts the burden on the insurance industry to provide clinically appropriate standards of care to justify treating mental health claims differently than medical-surgical claims. Mental health and substance disorder patients have a right to know whether they are being treated differently than patients with other physical or surgical issues, and if so, on what clinical grounds the insurance companies justify that difference.” The APA assisted the plaintiff’s counsel in briefing the MHPAEA arguments in this case, has filed another lawsuit against insurers Anthem and WellPoint, and is in the process of challenging several other insurance carriers it believes are violating mental health parity.
Lead attorney representing C.M., Alison J. Bell, partner at Langrock Sperry & Wool, LLP, said, “Mental health parity is an important lifeline for my client, who was denied benefits for medical care desperately needed in order to live a healthy life. We are grateful for the APA’s assistance with MHPAEA issues.”
Meiram Bendat, founder of Psych-Appeal, which assists mental health professionals and their patients in challenging insurance denials for mental health treatment, added “Psych-Appeal has worked hard to bring the parity issues to the forefront in this case and proudly hails its collaboration with plaintiff's counsel and the American Psychiatric Association."
Last weekend, former Congressman Patrick Kennedy held a round table discussion with psychiatrists, patients, mental health advocates, and political leaders about mental health parity, and the need for patients to speak out publicly about disparate treatment of mental health claims in order to ensure that the full vision of MHPAEA is realized. (Read one of the patient stories as previously provided in hearings held by the Connecticut Health Care Advocate’s office.) James Scully, CEO and Medical Director of the APA stated, “The APA applauds plaintiff C.M. and others who spoke at the round table last week for having the courage to stand up for the right to care. We look forward to the day when parity is fully realized and those with a mental illness and/or substance use disorders can expend their energy and resources conquering the illness, rather than battling the insurance companies for the coverage to which they are entitled and for which they and their employer have paid.”
The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.
Parity Laws: Powerful Weapon--or Pipe Dream?
By Heidi Anne Duerr, MPH
Psychiatric Times
Originally published May 6, 2013
Is true mental health parity really possible, even with the Mental Health Parity and Addiction Equity Act (MHPAEA)? It’s beginning to look like the answer is maybe–but only with a fight.
Across the US, the war for parity is being fought, with numerous law suits asking courts to help ensure the law has real bite. In the meantime, does this mean patients without legal support and know-how are going without proper care—or that real parity is just a pipe dream?
Just recently, the US District Court for the District of Vermont was the first court to interpret and support the MHPAEA.1 In this case, the plaintiff alleged Fletcher Allen Health Care Inc, the plaintiff’s health plan administrator, violated the parity law “by imposing, both in writing and in practice, more stringent reviews for mental health benefits than are imposed for medical benefits.”
Specifically, the complaint noted the insurer “conducts prospective and concurrent medical necessity reviews of routine, outpatient, out-of-network mental health office visits while … [the plan] conducts no such reviews for comparable medical office visits.” In addition, the plaintiff alleged that the plan “imposes a numeric cap on the number of routine outpatient visits participants may request before pre-approval is required for all subsequent medical necessity reviews.”
Meanwhile, the New York State Psychiatric Association filed a class-action suit against UnitedHealth Group for violating both federal and state antidiscrimination laws. Among other complaints, the suit noted UnitedHealth Group denied or delayed access to care and required continuing authorizations for psychotherapy, intensive outpatient treatment, and partial hospitalization.
The entire story is here.
Psychiatric Times
Originally published May 6, 2013
Is true mental health parity really possible, even with the Mental Health Parity and Addiction Equity Act (MHPAEA)? It’s beginning to look like the answer is maybe–but only with a fight.
Across the US, the war for parity is being fought, with numerous law suits asking courts to help ensure the law has real bite. In the meantime, does this mean patients without legal support and know-how are going without proper care—or that real parity is just a pipe dream?
Just recently, the US District Court for the District of Vermont was the first court to interpret and support the MHPAEA.1 In this case, the plaintiff alleged Fletcher Allen Health Care Inc, the plaintiff’s health plan administrator, violated the parity law “by imposing, both in writing and in practice, more stringent reviews for mental health benefits than are imposed for medical benefits.”
Specifically, the complaint noted the insurer “conducts prospective and concurrent medical necessity reviews of routine, outpatient, out-of-network mental health office visits while … [the plan] conducts no such reviews for comparable medical office visits.” In addition, the plaintiff alleged that the plan “imposes a numeric cap on the number of routine outpatient visits participants may request before pre-approval is required for all subsequent medical necessity reviews.”
Meanwhile, the New York State Psychiatric Association filed a class-action suit against UnitedHealth Group for violating both federal and state antidiscrimination laws. Among other complaints, the suit noted UnitedHealth Group denied or delayed access to care and required continuing authorizations for psychotherapy, intensive outpatient treatment, and partial hospitalization.
The entire story is here.
Tuesday, March 19, 2013
UnitedHealth Sued by Over Mental Health-Care Access
By Christie Smythe
Bloomberg News
Originally published March 11, 2013
UnitedHealth Group Inc. (UNH) was sued by the New York State Psychiatric Association and mental-health patients over claims the insurer violated laws barring unequal coverage for psychiatric conditions.
UnitedHealth, the second-largest U.S. health insurer, has maintained “unjustifiably stringent medical-necessity criteria and pre-authorization requirements for mental-health services,” the plaintiffs said in a complaint filed today in federal court in Manhattan.
The company denied or limited access to psychotherapy and other mental-health treatments for patients suffering from conditions including psychosis, chronic depression, and anxiety disorders, according to the 102-page complaint, which seeks to represent all customers of the company facing similar situations.
The entire article is here.
Bloomberg News
Originally published March 11, 2013
UnitedHealth Group Inc. (UNH) was sued by the New York State Psychiatric Association and mental-health patients over claims the insurer violated laws barring unequal coverage for psychiatric conditions.
UnitedHealth, the second-largest U.S. health insurer, has maintained “unjustifiably stringent medical-necessity criteria and pre-authorization requirements for mental-health services,” the plaintiffs said in a complaint filed today in federal court in Manhattan.
The company denied or limited access to psychotherapy and other mental-health treatments for patients suffering from conditions including psychosis, chronic depression, and anxiety disorders, according to the 102-page complaint, which seeks to represent all customers of the company facing similar situations.
The entire article is here.
Monday, February 25, 2013
New Federal Rule Requires Insurers to Offer Mental Health Coverage
By ROBERT PEAR
The New York Times
Published: February 20, 2013
The Obama administration issued a final rule on Wednesday defining “essential health benefits” that must be offered by most health insurance plans next year, and it said that 32 million people would gain access to coverage of mental health care as a result.
The federal rule requires insurers to cover treatment of mental illnesses, behavioral disorders, drug addiction and alcohol abuse, and other conditions.
Kathleen Sebelius, the secretary of health and human services, said that in addition to the millions who would gain access to mental health care, 30 million people who already have some mental health coverage will see improvements in benefits.
White House officials described the rule as a major expansion of coverage. In the past, they said, nearly 20 percent of people buying insurance on their own did not have coverage for mental health services, and nearly one-third had no coverage for treatment of substance abuse.
The entire story is here.
The New York Times
Published: February 20, 2013
The Obama administration issued a final rule on Wednesday defining “essential health benefits” that must be offered by most health insurance plans next year, and it said that 32 million people would gain access to coverage of mental health care as a result.
The federal rule requires insurers to cover treatment of mental illnesses, behavioral disorders, drug addiction and alcohol abuse, and other conditions.
Kathleen Sebelius, the secretary of health and human services, said that in addition to the millions who would gain access to mental health care, 30 million people who already have some mental health coverage will see improvements in benefits.
White House officials described the rule as a major expansion of coverage. In the past, they said, nearly 20 percent of people buying insurance on their own did not have coverage for mental health services, and nearly one-third had no coverage for treatment of substance abuse.
The entire story is here.
Tuesday, February 19, 2013
Impending rules will guide equality for mental health
By Kelly Kennedy
USA Today
Originally published February 6, 2013
Regulations to be issued this month on the type of mental health coverage insurers must provide under the 2010 health care law may elevate mental illness to the status it needs, mental health experts say.
"Mental health solutions aren't likely to have an impact on this kind of violence," said Jennifer Mathis, deputy legal director of the Bazelon Center for Mental Health Law. "But we have a broken mental health system, and this is an opportunity to rectify that. You take your opportunities where they are."
Since the shooting of 26 people at Sandy Hook Elementary School in Newtown, Conn., President Obama has signed several executive actions designed to identify and help those with mental illness.
He has called for a discussion about mental health and has vowed to issue final rules this month that extend mental health parity to everyone who has health insurance under the health care law, also known as the Affordable Care Act.
Those regulations would go into effect in January, and though the specifics of those rules are unknown, advocates have clear ideas of what they'd like to see parity look like.
"In a broad-speaking way, we want to see parity be about what outcomes are, not specific tit-for-tat," said Debbie Plotnick, senior director of state policy at Mental Health America, a non-profit group that promotes mental wellness.
The entire story is here.
USA Today
Originally published February 6, 2013
Regulations to be issued this month on the type of mental health coverage insurers must provide under the 2010 health care law may elevate mental illness to the status it needs, mental health experts say.
"Mental health solutions aren't likely to have an impact on this kind of violence," said Jennifer Mathis, deputy legal director of the Bazelon Center for Mental Health Law. "But we have a broken mental health system, and this is an opportunity to rectify that. You take your opportunities where they are."
Since the shooting of 26 people at Sandy Hook Elementary School in Newtown, Conn., President Obama has signed several executive actions designed to identify and help those with mental illness.
He has called for a discussion about mental health and has vowed to issue final rules this month that extend mental health parity to everyone who has health insurance under the health care law, also known as the Affordable Care Act.
Those regulations would go into effect in January, and though the specifics of those rules are unknown, advocates have clear ideas of what they'd like to see parity look like.
"In a broad-speaking way, we want to see parity be about what outcomes are, not specific tit-for-tat," said Debbie Plotnick, senior director of state policy at Mental Health America, a non-profit group that promotes mental wellness.
The entire story is here.
Sunday, July 15, 2012
Good News for Mental Illness in Health Law
By Richard A. Friedman, MD
The New York Times
Originally published July 9, 2012
The New York Times
Originally published July 9, 2012
Americans with mental illness had good reason to celebrate when the Supreme Court upheld President Obama’s Affordable Care Act. The law promises to give them something they have never had before: near-universal health insurance, not just for their medical problems but for psychiatric disorders as well.
Until now, people with mental illness and substance disorders have faced stingy annual and lifetime caps on coverage, higher deductibles or simply no coverage at all.
This was supposed to be fixed in part by the Mental Health Parity and Addiction Equity Act of 2008, which mandated that psychiatric illness be covered just the same as other medical illnesses. But the law applied only to larger employers (50 or more workers) that offered a health plan with benefits for mental health and substance abuse. Since it did not mandate universal psychiatric benefits, it had a limited effect on the disparity between the treatment of psychiatric and nonpsychiatric medical diseases.
Subscribe to:
Posts (Atom)