HealthReform.gov, managed by the U.S. Department of Health & Human Services, is online to answer consumer and stakeholder questions about the Patient Protection and Affordable Care Act - H.R. 3590, signed into law by President Obama on March 23, 2010; now Public Law No: 111-148 (text of P.L. not yet posted at the Government Printing Office).
There is also a weekly live web chat to answer questions and address various aspects of the law. Past chats are also archived for any unable to make the live chat.
"This Thursday, May 20, 2010 1PM EDT, the web chat topic is how the Affordable Care Act will benefit Americans with disabilities. Submit questions for the chat to healthreform@hhs.gov. You can watch the web chat live at: http://www.hhs.gov/live.
Do you have a disability or have someone close to you who does? Do you wonder if and how the Affordable Care Act can really help you? We'll be taking your questions about how the Affordable Care Act will benefit people with disabilities, or those with loved ones affected by a disability. Join our WebChat this upcoming Thursday, May 20, at 1:00 P.M EDT at www.hhs.gov/live.
Henry Claypool, the Director of the Office of Disability at HHS, Jeffrey Crowley, Senior Advisor on Disability Policy at the White House and Meena Seshamani, Deputy Director in the Office of Health Reform at HHS will discuss and answer YOUR questions about how the Affordable Care Act will help those who have a disability.
Send your questions to healthreform@hhs.gov and we'll answer as many as possible during Chat. We will also take questions live from twitter using our handle @HHSGOV.
This week's show is the eighth in the Affordable Care Act WebChat series. Tune in each week as we continue to talk about different aspects of the new health reform bill so that you, your family and friends can stay informed. You can find previous WebChats on healthreform.gov and browse the site to find all the latest information available from HHS on the new law. Thanks for participating, and stay tuned to get your questions answered."
"The new members will bring additional points of view and expertise to the IACC...'By adding new voices to the IACC and expanding the number of organizations represented on the committee, we hope to broaden our perspectives and increase coordination efforts,' said Dr. Thomas Insel, IACC Chairman and director of the National Institute of Mental Health, part of the National Institutes of Health (NIH)."
New Members of the Interagency Autism Coordinating Committee:
Dr. Dawson is the Chief Science Officer for Autism Speaks, working with the scientific community and stakeholders to shape and expand the foundation's scientific vision. She also is a licensed clinical psychologist with a research focus on early detection and intervention, early patterns of brain dysfunction and the identification of biological markers for autism genetic studies. Dr. Dawson also serves as Research Professor of Psychiatry at the University of North Carolina at Chapel Hill, Adjunct Professor of Psychiatry at Columbia University and Professor Emeritus of Psychology at University of Washington.
Dr. Fischbach is the Scientific Director for the Simons Foundation, where he oversees the Autism Research Initiative. He has spent his career as a neuroscientist studying the formation and maintenance of synapses, the junctions between nerve cells which allow signals to be transmitted. Before joining the Simons Foundation, Dr. Fischbach served as the Director of the National Institute of Neurological Disorders and Stroke (NINDS) from 1998 to 2001 and as the Executive Vice President of Columbia University Medical Center and Dean of the faculties of medicine from 2001 to 2006.
Mr. Ari Ne'eman is the Founding President of the Autistic Self Advocacy Network, where he works to increase the representation of autistic people in public policy discussions. He is an adult on the autism spectrum and a leading advocate in the neurodiversity movement. Mr. Ne'eman has served on the New Jersey Adults with Autism Task Force and the New Jersey Special Education Review Commission, where he authored a minority report advocating legislative action against the use of aversives, restraint and seclusion. He is a board member of TASH, an advocacy group for people with disabilities, and is involved with the Maryland Coalition for Inclusive Education.
The Interagency Autism Coordinating Committee (IACC) - the Federal advisory committee mandated by The Combating Autism Act (CAA) of 2006 (P.L. 109-416 – ) to coordinate research activities within the U.S. Department of Health and Human Services - and the Office of Autism Research Coordination (OARC), will be holding a full meeting of the Committee on Friday, April 30, 2010.
The Ronald Reagan Building and International Trade Center Rotunda Room
1300 Pennsylvania Avenue, N.W.
Washington, DC 20004
This meeting will also be available to the public by live videocast.
Schedule subject to change. Meeting may end prior to or later than 5:00 p.m. depending on the needs of the committee.
See the agenda website for full schedule and link to the videocast
Of particular interest may be, Research Update: Autism Treatment Network
Geraldine Dawson, Ph.D.
Chief Science Officer, Autism Speaks
Research Update: Autism in the DSM-V
Susan E. Swedo, M.D.
Senior Investigator, Behavioral Pediatrics Section
Pediatrics and Developmental Neurospsychiatry Branch, NIMH
Research Update: NIH Nonverbal ASD Workshop
Helen Tager-Flusberg, Ph.D.
Director, Laboratory of Developmental Cognitive Neuroscience, Boston University
Ann Wagner, Ph.D.
Chief, Neurobehavioral Mechanisms and Mental Disorders Branch, NIMH
Research Update: Building the Infrastructure for Comparative Effectiveness Research on Disability Issues
Rosaly Correa-de-Araujo, M.D., MSc, Ph.D.
Deputy Director, Office on Disability, Office of the Secretary
On April 15, 2010 the the Healthy Families and Communities Subcommittee of the U.S. House Committee on Education & Labor heard testimony on the topic of
"...Research notes that corporal punishment [defined as the intentional application of physical pain as a method of behavior change - see testimony for specific named practices and citations] constructs an environment of education that can be described as unproductive, nullifying, and punitive. Children become victims, and trepidation is introduced to all in such a classroom. There is a limited (if any) sense of confidence and security; even those children who witness this type of abuse are robbed of their full learning potential... It is critical that teachers receive adequate training and resources to help them effectively maintain classroom control without resorting to violent or aggressive techniques.2 One way to accomplish this is to provide teachers, both during pre-service and in-service training, with the ability to employ behavior management techniques that promote pro-social classroom interactions among the students; this would also promote a positive learning environment for those students..."
It is reported that currently there is no U.S. federal regulation on corporal punishment in schools although thirty states have prohibited the practice. The twenty remaining states are primarily in the South. A recent Washington Post article reports that the Chairperson of the Subcommittee, Representative Carolyn McCarthy, plans to introduce in a matter of weeks a resolution to ban the use of corporal punishment in U.S. Schools.
Among the citations and references supplied to the Subcommittee by Dr. Greydanus were,
The two bills that would establish Federal regulation of the use of restraint and seclusion in U.S. Schools and their prohibition in Individualized Education Plans (IEPs), are currently in the U.S. Senate Committee on Health, Education, Labor, & Pensions (HELP). The House Committee on Education and Labor is examining the use of corporal punishment in schools and the effect on academic achievement.
With the Senate returning from its 2-week break, advocacy groups have begun "phone-in" days for S. 2860, urging Committee action for passage in the current Congress.
On a related note, the House Committee on Education and Labor will be holding a Healthy Families and Communities Subcommittee meeting on Thursday, April 15, 2010, 10:00 AM, 2175 Rayburn H.O.B Washington, DC. Witness to be announced.
Both Committees are also actively taking testimony in the overhaul and re-authorization of the Elementary and Secondary Education Act (ESEA), currently known as "No Child Left Behind".
Conference Call and Webinar of the Subcommittee for Planning the Annual Strategic Plan Updating Process Monday, April 19, 2009 from 10:00 a.m. to 12:00 p.m. ET. The agenda is to discuss plans for updating the 2010 IACC Strategic Plan for Autism Spectrum Disorder Research.
The public is welcome to participate and no registration is required.
The Contact Person for this conference call is:
Ms. Lina Perez
Office of Autism Research Coordination
National Institute of Mental Health, NIH
6001 Executive Boulevard, NSC
Room 8185a
Rockville, MD 20852
Phone: 301-443-6040
IACCpublicinquiries@mail.nih.gov
"coordinate all efforts within the Department of Health and Human Services concerning autism spectrum disorder to combat autism through research, screening, intervention and education. The Committee’s primary mission is to facilitate the efficient and effective exchange of information on autism activities among the member agencies, and to coordinate autism-related programs and initiatives"
in which the IACC identifies what they have selected as the twenty top studies from the peer-reviewed literature of 2009 providing significant insight into prevalence, biology, potential risk factors and possible interventions related to autism spectrum disorders.
The current report has a somewhat different format than the prior reports of 2008 and 2007 in being more of a list of articles than a background document.
The twenty articles selected for 2009 from the 63 nominated are,
An amended reconciliation bill H.R. 4872 passed in the U.S. House Thursday night, March 25, 2010 by a vote of 220 to 207 on the motion to concur with the Senate amendments after its return from the Senate earlier in the day. In the Senate, the vote was 56 to 42. The vote split approximately down political party lines, with Republicans in both chambers unanimously opposed.
National Public Radio reports that the first task resulting from the new laws would be establishment of a federally funded "high-risk pool" program to cover those turned down for preexisting conditions by private insurance. Currently the law would call for 90 days to do so. NPR also describes some of the related details.
Among some of the questions still circulating is the cost of the laws.
The Congressional Budget Office (CBO) recently issued reports of their assessment and analysis of national costs/benefits of health care (and education) reform specific to this legislation (H.R. 4872 & H.R. 3950).
Three minor parlimentary challenges in the reconciliation act H.R. 4872, which would implement desired House amendments to the recently signed into law health reform bill H.R. 3590 , have flagged the measure for a return to the U.S. House of Representatives after U.S. Senate approval.
One problemative provision was in the educational portion of the bill dealing with the calculation formula of student Pell grants in the portion of H.R. 4872 dealing with restructuring of student education loans, another was characterized as insignificant and technical; both removed from the bill. A third is under review by the Senate Parlimentarian, but is also considered minor. None of these are considered significant enough to delay final approval of H.R. 4872.
Prior to these successful parlimentary challenges, Senators voted on and defeated 29 consecutive GOP amendments in a marathon voting session between 5:30 PM.EDT Wednesday and 2:45 AM EDT Thursday, when they recessed.
The Senate has been ordered to reconvene at 9:15AM EDT on Thursday, March 25. Some predictions are that voting on the reconciliation in the Senate will conclude sometime on Thursday, and that the House will readdress H.R 4872 on Friday, March 26, 2010.
The Autism Speaks blog has put up a post in which they identify what is seen as the outcome from the passage of S. 3590 and the potential passage of H.R. 4872.
While the post is posed in general terms, there are comments related to those plans under the Employee Retirement Income Security Act of 1974 (ERISA) not being required to provide the essential benefits package requiring "behavioral health", and what they see as benefits and effects on state mandates.
Will health care reform directly benefit the autism community?
Does it apply to all insurers?
How does health care reform impact the state autism insurance reform effort?
The short version is that passage of the Federal health care reform, while projected as a positive outcome for the country as a whole, is not a universal solution to the coverage and reimbursement problems currently facing families with a child who has an autism diagnosis, and that Autism Speaks' assessment is that obtaining uniform coverage providing behavior analytic treatment for those with an autism diagnosis will require continuing advocacy and legislation at both Federal and State levels. That blog also welcomes comments and questions.
which is the Senate version of health care reform that was originally passed by the Senate on December 24, 2009. H.R. 3590 is scheduled to be signed into law by President Obama on March 23, 2010 at 11:15 AM EDT.
Within minutes of the passage of H.R. 3590, the House also passed by a vote of 220 to 211 a reconciliation bill,
which encompasses amendments to H.R. 3590 proposed by the House. The U.S. Senate still has to deliberate and approve H.R. 4872; it is required to commence those deliberations after H.R. 3590 is enacted into law by the President's signature, to allot at least 20 hours of debate to the matter, and due to technicalities the reconciliation bill requires only a simple majority for passage. The Senate calendar shows deliberation on H.R. 4872 commencing Tuesday, March 23, 2010 at 2:15PM EDT, although it is possible that could change.
H.R. 3590 does include a behavioral health provision for mental health and substance abuse treatment, however behavior analysts are not listed among those providers explicitly identified for reimbursement as part of a treatment team. It has also been noted by Autism Votes that the behavioral health clauses as enacted do not have sufficient reach to benefit more than a relative minority of families seeking ABA services, since this coverage is not required for all plans excepting,
(1) plans offered by state-based exchanges, through which individuals and small businesses can purchase coverage; and
(2) plans offered in the individual and small group markets outside the exchange.
The Arc struck a more optimistic note in changes that it sees as improvements in coverages, benefits and Long-Term Supports for those with developmental disabilities.
The reconciliation act, H.R. 4872 makes additional specification for covered professionals, under,
TITLE K--PROMOTING PRIMARY CARE, MENTAL HEALTH SERVICES, AND COORDINATED CARE
Sec. 1308. Coverage of marriage and family therapist services and mental health counselor services.
News reports and analysis will undoubtedly continue over the coming days clarifying the relative strengths and weaknesses of the enacted legislation, with some dependency on the outcome of the Senate actions yet to occur on H.R. 4872.
The Arc Applauds House Passage of Health Care Reform Legislation 3/22/2010
Washington, D.C. (March 22, 2010) - Press Release
Describes changes that The Arc sees as positive in coverages, benefits and Long-Term Services and Supports for those with developmental disabilities
Below is a press release from the U.S. Department of Justice announcing a request for a preliminary injunction against the Conway Human Development Center in Conway, AR. The filing, besides its own stated merits, provides a case study on several grounds: the nature of the points made in the DOJ's filing and prior discovery; the background of lack of appropriate training in and application of behavioral assessment and intervention for both behavior management and re/habilitative purposes; allegations of violation of FAPE/IDEA; what constitutes appropriate standards of care and ethical professional practice; the discussion of Federal statute and prior case law in application of certain techniques, monitoring and community-based care. Links in this post were added to press release text to simplify access to primary documents referenced.
-----------------------------
"Department of Justice
Office of Public Affairs
FOR IMMEDIATE RELEASE
Tuesday, March 9, 2010
Justice Department Files for Immediate Relief Regarding Conditions at Conway Human Development Center, in Conway, Arkansas
The Justice Department today asked the Federal District Court for the Eastern District of Arkansas to take immediate action to prevent children from being admitted to the Conway Human Development Center(CHDC) in Conway, Ark. The department’s motion for preliminary injunction aims to prevent the segregation of children with developmental disabilities in dangerous conditions and to address accusations of imminent and serious threats to the safety of the facility’s more than 500 current residents.
In January 2009, the Justice Department filed a complaint against the State of Arkansas to enforce the federal requirement that individuals with disabilities be served in the most integrated settings appropriate, and to remedy unconstitutional conditions at CHDC. Information collected through discovery since the filing of the complaint has led the department to conclude that residents face increasing and grave risk of harm with each day that deficiencies are ignored, and that Arkansas fails to serve individuals in the most integrated setting appropriate to the residents’ needs.
The United States has concluded that children at the facility are particularly vulnerable given allegations that CHDC residents are subjected to dangerous medication mismanagement and harmful, unnecessary restraints. In recent years, at least three CHDC residents have died, suffered possible permanent organ damage or been at risk of hemorrhaging to death because of psychotropic medication mismanagement. CHDC also continues to utilize 41 different forms of mechanical restraints on both children and adults, including straitjackets, restraint chairs and papoose boards - practices that have been largely barred from other facilities for years.
"The State has a responsibility to ensure the safety of individuals who reside in state-run facilities, and we must act swiftly when the state does not live up to that responsibility," said Thomas E. Perez, Assistant Attorney General in charge of the Civil Rights Division. "Individuals with developmental disabilities have the right to live in the most integrated setting appropriate to their needs, and states must take swift action to ensure that all individuals are accorded these basic rights."
In addition to barring inappropriate restraints and requiring safeguards to prevent dangerous medication practices, the motion seeks to require that the state remove barriers to the provision of supports and services in the community, so that individuals with disabilities, including the approximately 50 children at CHDC, are not forced to choose between an unsafe institution and the denial of necessary services in a more integrated setting.
Between June 1, 2007, and Oct. 1, 2009, a CHDC resident was more likely to die than be discharged to a more integrated setting. On average, CHDC residents die at the age of 46.5 years, compared with the average age of 72 years for other individuals with developmental disabilities living in institutional settings. The number of individuals with developmental disabilities who are waiting to receive community-based services is on the rise in Arkansas, with over 1,300 currently waiting to receive services through the Centers for Medicaid and Medicare Services Alternative Community Services waiver program, with an average wait time of approximately two and a half years.
The Civil Rights Division is authorized to conduct investigations under the Civil Rights of Institutionalized Persons Act (CRIPA) and the Americans with Disabilities Act of 1990 (ADA). CRIPA authorizes the Attorney General to investigate conditions of confinement in certain institutions owned or operated by, or on behalf of, state and local governments. In addition to residential facilities serving persons with developmental disabilities, these institutions include psychiatric hospitals, nursing homes, jails, prisons and juvenile correctional facilities. The ADA authorizes the Attorney General to investigate whether a state is serving individuals in the most integrated settings appropriate to their needs. Please visit http://www.justice.gov/crt to learn more about CRIPA, the ADA and other laws enforced by the Justice Department’s Civil Rights Division.
"MADISON – Governor Jim Doyle today announced that mental health disorders, including autism spectrum disorders, will now be covered by health insurance providers at the same level as all other health conditions. Implementation of the federal mental health parity law in Wisconsin will help people access mental health treatment they need, and families pursue all available treatments for children with autism. The new federal requirement builds on the state’s requirement that all health insurance companies cover mental health and new requirement for coverage of autism treatment, which Governor Doyle signed into law in the 2009-2011 state budget...
The federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requirements will require equal treatment coverage of mental health conditions including autism. Wisconsin families enrolled in large group health plans will be affected by these changes. Individual, small employer, and self-funded insurance plans will still have to comply with state autism coverage requirements..."
On a related note, Wisconsin's legislature is currently deliberating
which would provide mental health and substance abuse disorder insurance benefits at parity levels—equal to benefits for medical and surgical procedures—for 700,000 employees of Wisconsin’s small businesses not covered by the Federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, P.L. 110-343. Senate Substitute Amendment 1 to SB-362 was passed in the Senate on January 28, 2010 and is currently in the Assembly, referred to the Committee on Rules. Assembly Bill 512 was passed with a do pass as amended recommendation from the Assembly Committee on Health and Healthcare Reform on February 26, 2010 and is also in the Committee on Rules at the present.
This evening, March 3, 2010, the U.S. House of Representatives passed by a vote of 262 to 153, the House Committee on Education and Labor Substitute for H.R. 4247, formerly known as the "Preventing Harmful Restraint and Seclusion in Schools Act", and now renamed,
"...The Keeping All Students Safe Act would establish, for the first time, minimum federal standards to provide equal protections to all students, in every state across the country. It would make clear that physical restraint or locked seclusion should be used only when there is imminent danger of injury and only when imposed by trained staff. It would prohibit mechanical restraints, such as strapping children to chairs, misusing therapeutic equipment to punish students or duct-taping parts of their bodies and any restraint that restricts breathing.
It would also prohibit chemical restraint, which are medications used to control behavior that are not consistent with a doctor’s prescription.
The bill would prohibit school staff from including restraint or seclusion as planned interventions in student’s education plans, known as Individualized Education Programs (IEPs). It would also require schools to notify parents immediately after incidents when restraint or seclusion was used..."
If H.R. 4247 progresses to Federal law, it would apply to all public and private schools which accept Federal funding, and all states would be expected to comply with, if not exceed, the conditions specified in the bill.
Progress of H.R. 4247 is dependent on what action is taken in the House, but it has been anticipated that if it passes in that chamber, that a conference committee would work to consolidate proposals within H.R. 4247 and those within S. 2860: Preventing Harmful Restraint and Seclusion in Schools Act, which was introduced in the U.S. Senate and is currently in the Senate Committee on Health, Education, Labor, and Pensions.
Inside Behavior Analysis
Volume 1 | 2009 | Number 2 | On-line ISSN: 2151-4704 ABAI Practice Board
(About 3/4 of the way down the page.)
"Position Statements
The ABAI Council assembles task forces to study critical issues within the field and to develop white papers for submittal to the Association' s Full Members for input and votes. Most recently, a task force on seclusion and restraint has been formed, with joint participation of the Science and Practice Boards. The task force will develop and recommend a position statement on the appropriate use of seclusion and restraint for consideration by ABAI Full Members. Participants in the task force include Jon Bailey, Michael F. Dorsey, Louis P. Hagopian, Gregory P. Hanley, David B. Lennox, Mary M. Riordan, Scott Spreat, and Timothy R. Vollmer. "
Please note that the deadline for responding to this RFI is Friday, February 19th, 2010. OppNet is seeking your help in identifying broad priority areas. The purpose of this RFI is not to solicit ideas for specific, individual research proposals.
OppNet Mission
The mission of OppNet is to pursue opportunities for strengthening basic behavioral and social science research (b-BSSR) at the NIH while innovating beyond existing investments.
OppNet Goals
OppNet advances basic behavioral and social science research through activities and initiatives that build a body of knowledge about the nature of behavior and social systems.
OppNet prioritizes activities and initiatives that focus on basic mechanisms of behavior and social processes; that are relevant to the missions and public health challenges of multiple NIH Institutes, Centers and Offices (ICOs); and that build upon existing NIH investments without replicating them.
There are several online resources that may be helpful to those interested in tracking autism-related legislation and implementation, and associated state conditions,
For all Federal legislation and public law, searches can be conducted by keyword or resolution number using Thomas.gov, the search engine of the Library of Congress.
For helpful reference on state background on autism counts and services is the
State profile page at Easter Seals, which provides information on
Demographics,
State Task Forces & reports,
State Insurance Coverage,
Other State Activity,
Education Programs and Activities
The information is current to 2009 (with availability of 2008 data), but these State Autism Profiles provide a helpful quick snapshot of what the situation is in a state.
A dynamic searchable database is the NCSL Autism Legislation Database. The database is searchable by all states, District of Columbia, and U.S. Territories, and by year under the categories of,
Awareness
Education
Financing
Health and Human Services
Infrastructure
Insurance
Miscellaneous
Professional Training
Screening
Task Force
A personal recommendation is that search results of interest should be cross-checked and verified against legislative websites, since the information is dependent on when the database is updated and may lag real events by a few days. Nonetheless, the NCSL database is of valuable service in giving a rapid snapshot of autism-related legislation and extends beyond questions of insurance.
(A note of appreciation and thanks to Kimberly Derk, MA, BCBA for highlighting this useful resource.)
A helpful website available to those looking for grant and research opportunties is grants.gov. There is information on new and current grant opportunities, application information and FAQs, basic search and browse functions, and RSS feeds and email alerting for notification of new grant opportunities.
The U.S. Departments of Labor, Health and Human Services (HHS), and the Treasury on January 29, 2010 issued the awaited interim final rules [http://edocket.access.gpo.gov/2010/pdf/2010-2167.pdf ] resulting from passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The notice/press release below outlines changes resulting from the passage of MHPAEA, and requests comment during a comment period of 90 days on certain areas of the interim final rules. While the notice/press release is retained in full, some areas have been highlighted and bulleted to emphasize important areas of the law's requirements, areas that comment are being requested for, how to submit comments on the MHPEA interim rules, and how to request materials in an alternative accessible format. ----------------------------------------
Paul Wellstone, Pete Domenici Parity Act prohibits discrimination
WASHINGTON, Jan. 29 /PRNewswire-USNewswire/ -- The U.S. Departments of Labor, Health and Human Services (HHS), and the Treasury today jointly issued new rules providing parity for consumers enrolled in group health plans who need treatment for mental health or substance use disorders.
"Today's rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services," said U.S. Secretary of Labor Hilda L. Solis. "The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society. That is not just sound policy, it's the right thing to do."
"The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care," said Secretary of Health and Human Services Kathleen Sebelius. "I applaud the longstanding and bipartisan effort that made these important new protections possible."
"Workers covered by group health plans who need mental health and substance abuse care deserve fair treatment," said Deputy Treasury Secretary Neal Wolin. "These rules expand on existing protections to ensure that people don't face unnecessary barriers to the treatment they need."
The new rules prohibit group health insurance plans — typically offered by employers — from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits. The rules implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
MHPAEA greatly expands on an earlier law, the Mental Health Parity Act of 1996, which required parity only in aggregate lifetime and annual dollar limits between the categories of benefits and did not extend to substance use disorder benefits.
The new law requires that
any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review.
These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits.
For example, a plan may not apply separate deductibles for treatment related to mental health or substance use disorders and medical or surgical benefits. They must be calculated as one limit.
MHPAEA applies to employers with 50 or more workers whose group health plans choose to offer mental health or substance use disorder benefits.
The new rules are effective for plan years beginning on or after July 1, 2010.
The Wellstone-Domenici Act is named for two dominant figures in the quest for equal treatment of benefits. The late Sen. Paul Wellstone, D-Minn., who was a vocal advocate for parity throughout his Senate career, sponsored the ultimately successful full parity act. He was joined by former Sen. Pete Domenici, R-N.M., who first introduced legislation to require parity in 1992. Champions of the legislation also included the bipartisan team of Rep. Patrick Kennedy, D-R.I., and former Rep. Jim Ramstad, R-Minn.
The issue of parity dates back more than 40 years to President John F. Kennedy, and also was supported by President Clinton and the late Sen. Edward Kennedy.
The released interim final rules released today were developed based on the departments' review of more than 400 public comments on how the parity rule should be written. Comments on the interim final rules are still being solicited.
Sections where further comments are being specifically sought include so-called "non quantitative" treatment limits such as those that pertain to the
scope and duration of covered benefits,
how covered drugs are determined (formularies) and
the coverage of step-therapies.
Comments are also being specifically requested on the regulation's section on "scope of benefits" or continuum of care.
Comments on the interim final regulation are due 90 days after the publication date. Comments may be emailed to the federal rulemaking portal at http://www.regulations.gov.
Comments directed to HHS should include the file code CMS-4140-IFC.
Comments to the Department of Labor should be identified by RIN 1210-AB30.
Comments to the Treasury's Internal Revenue Service should be identified by REG-120692-09.
Comments may be sent to any of the three departments and will be shared with the other departments.
Please do not submit duplicates.
U.S. Department of Labor releases are accessible on the Internet at http://www.dol.gov. The information in this news release will be made available in alternate format (large print, Braille, audio tape or disc) from the COAST office upon request. Please specify which news release when placing your request at 202-693-7828 or TTY 202-693-7755. The Labor Department is committed to providing America's employers and employees with easy access to understandable information on how to comply with its laws and regulations. For more information, please visit http://www.dol.gov/compliance.
SOURCE U.S. Department of Labor
RELATED LINKS http://www.dol.gov ------------------------------------ For more information:
Federal Register: Tuesday, February 2, 2010 Part IV: Department of the Treasury, Internal Revenue Service, 26 CFR Part 54 Department of Labor, Employee Benefits Security Administration, 29 CFR Part 2590 Department of Health and Human Services, Centers for Medicare & Medicaid Services, 45 CFR Part 146 Interim Final Rules Under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Final Rule http://edocket.access.gpo.gov/2010/pdf/2010-2167.pdf
Good summary article of the rules release, application and comment submission Registration required to access. Interim rule issued on mental health parity ModernHealthcare.com By Jessica Zigmond Posted: January 29, 2010 - 5:59 am ET
