MENTAL HEALTH AMERICA CALLS SUPREME COURT REVIEW OF HEALTH REFORM CRITICAL TO FUTURE OF PEOPLE LIVING WITH MENTAL HEALTH, SUBSTANCE USE CONDITIONS. - States News Service

ALEXANDRIA, VA -- The following information was released by the Mental Health America:

Mental Health America today called the Supreme Court's review of the constitutionality of health care reform critical to the future of millions of Americans living with mental health and substance use conditions who are being helped by the expansion of access to treatment.

The organization urged advocates to participate in events and activities across the country and to speak out in support of the law.

Mental Health America has joined in a friend of the court brief arguing that the law be upheld.

'The Affordable Care Act marks a tremendous step forward in our efforts to improve access to care for individuals with mental health or substance use conditions and in our advocacy for prevention of these conditions,' said David Shern, Ph.D., president and CEO of Mental Health America.

Dr. Shern said several key provisions that are already effective are improving the lives of millions of Americans with mental health and substance use conditions. These include:

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Children under the age of 19 can no longer be denied coverage based on a pre-existing condition--and insurers won't be able to use those conditions to raise premiums. (This provision will be extended to adults in January 2014.)

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For the first time, mental health and substance use disorder services are covered by requiring those benefits be included in plans offered to small businesses and individuals.

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The groundbreaking Mental Health Parity and Addiction Equity Act, and its prohibition of discriminatory limits on mental health and substance use services, is extended to those plans.

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The expansion of Medicaid also requires those who are newly eligible to receive mental health and substance use services at parity with other benefits.

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If a parents' plan provides coverage for dependent children, it is now required to cover children up to age 26.

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All new plans must offer co-payment- and deductible-free preventive services, including depression screening for adolescents and adults.

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Insurance companies can no longer set limits on the dollar amount of health benefits that they will cover in a year or over an individual's lifetime.

The requirement that coverage for dependent children must be available up to age 26 and additional funding for school-based health clinics--with the direction they include mental health and substance use services--are critical in light of the fact that mental health conditions often strike during the adolescent and young adult years.

'Most people with these conditions will not receive treatment until many years later, if at all,' Dr. Shern said. 'Extending coverage will help to address these issues.'

Among the many other important new programs and reforms are initiatives to support education and training of additional mental health and addiction treatment providers and to improve coordination of care through a new state option for medical/health homes in Medicaid that includes individuals with serious mental health conditions among the priority populations.

Dr. Shern said these provisions will be threatened if the Supreme Court finds the law unconstitutional.

Additional information on how the Affordable Care Act affects mental health treatment and services is available at: http://www.mentalhealthamerica.net/go/action/policy-issues-a-z/healthcare-reform.

Mental Health America (www.mentalhealthamerica.net) is the nation's largest and oldest community-based network dedicated to helping all Americans achieve wellness by living mentally healthier lives. With our more than 300 affiliates across the country, we touch the lives of millions--Advocating for changes in mental health and wellness policy; Educating the public and providing critical information; and delivering urgently needed mental health and wellness Programs and Services.

Oral Health America Applauds Oral Health Provisions in Health Care Reform Bill. - Managed Care Weekly Digest

The health care reform bill passed by Congress, and now signed into law by President Obama, includes many provisions that will improve the nation's oral health. Most significantly, the bill does guarantee oral health coverage for children and allows for resources to extend oral disease prevention measures in every state. Over time, the bill's provisions can help to increase access to care for all ages (see also Oral Health America).

'Oral Health America supports the numerous measures of the health care reform bill that represent real commitment on the part of our lawmakers to improve our nation's oral health,' said Beth Truett, President and CEO, Oral Health America. 'This is a great start, and we look forward to continued health reform opportunities to ensure that all Americans are able to obtain the preventive and restorative care they need.'

According to the bill, oral health care for children under 21 must be included in any essential benefit package offered by any health insurance exchange.

To help extend access to preventive care, the bill allows for school-based sealant programs in all 50 states, and an oral health education program targeting vulnerable populations, including children, pregnant women and older Americans. The bill also allows for grants totaling $60 million to be awarded to up to 15 programs to train or employ alternative dental health providers.

The Medicaid limit is now set at 133 percent of the Federal poverty level, meaning an additional 16 million people will be eligible for Medicaid coverage. Medicaid dental benefits for adults are still optional for states to provide or not, but states can no longer drop dental benefit packages they currently offer. Prior to the passage of the bill, Arizona was the last state in a disturbing national trend to drop its adult Medicaid dental program, and the first state to drop its Medicaid/Children's Health Insurance Program (CHIP), adversely affecting 38,000 low income children.

For America's growing population aged 65 and older, the bill represents no change to the fact that Medicare does not provide routine dental care benefits.

Oral Health America is a national, charitable non-profit, dedicated to connecting communities with resources to increase access to oral health care, education and advocacy for all Americans, especially those most vulnerable. For more information, visit www.oralhealthamerica.org.

Keywords: Economics, Health Insurance, Insurance, Pediatrics, Poverty Level, Oral Health America.

MENTAL HEALTH AMERICA MARKS SIX MONTH ANNIVERSARY OF HEALTH REFORM LAW. - States News Service

ALEXANDRIA, VA -- The following information was released by the Mental Health America:

Mental Health America today marked tomorrow's six month anniversary of the Affordable Care Act, which will greatly expand access to mental health care and addiction treatment.

'The Affordable Care Act marks a tremendous step forward in our efforts to improve access to care for individuals with mental health or substance use conditions and in our advocacy for prevention of these conditions,' said David Shern, Ph.D., president and CEO of Mental Health America.

'Treatment for these conditions is recognized as critical to overall health by being included on the list of essential benefits that must be covered in new plans offered to the uninsured beginning in 2014.'

Dr. Shern said several key provisions that take affect on September 23 will improve the lives of millions of Americans with mental health and substance use conditions. These include:

Children under the age of 19 can no longer be denied coverage based on a pre-existing condition. (This provision will be extended to adults in January 2014.)

If a parents' plan provides coverage for dependent children, it is now required to cover children up to age 26.

Insurance companies can no longer set limits on the dollar amount of health benefits that they will cover in a year or over an individual's lifetime.

All new plans must offer co-payment- and deductible-free preventive services, including depression screening for adolescents and adults.

The groundbreaking enactment of the 'Mental Health Parity and Addiction Treatment Act' (MHPAEA) firmly established that discriminatory limits on mental health and substance use conditions will no longer be permitted. The Affordable Care Act carries this principle forward and extends the MHPAEA requirements beyond current law to health insurance plans offered to small businesses and individuals. These principles are also reflected in the expansion of Medicaid which would require those newly eligible to receive mental health and substance use services at parity with other benefits.

Access to care will also be improved due to insurance market reforms in the new law that will prohibit pre-existing condition exclusions, rescissions of coverage when people most need it, pricing premiums based on health status, and annual and lifetime limits on benefits.

The requirement that coverage for dependent children must be available up to age 26 and additional funding for school-based health clinics are critical in light of the fact that mental health conditions often strike during the adolescent and young adult years but most will not receive treatment until many years later, if at all.

Mental Health America places a high priority on prevention, particularly among children and youth, and recognizes the critical importance of the requirements to cover preventive services and support for support community-based prevention activities.

Among the many other important new programs and reforms are initiatives to support education and training of additional mental health and addiction treatment providers and to improve coordination of care through a new state option for medical/health homes in Medicaid that includes individuals with serious mental health conditions among the priority populations.

Additional information on how the Affordable Care Act affects mental health treatment and services is available at: http://www.mentalhealthamerica.net/go/action/policy-issues-a-z/healthcare-reform.

Mental Health America is the country's leading nonprofit dedicated to helping all people live mentally healthier lives. With our century of service to America and our more than 300 affiliates nationwide,

MENTAL HEALTH AMERICA HAILS ENACTMENT OF HISTORIC HEALTH CARE REFORM BILL. - States News Service

ALEXANDRIA, VA -- The following information was released by the Mental Health America:

Mental Health America today hailed the 'Patient Protection and Affordable Care Act' signed by the President today. The legislation will greatly expand access to mental health care and addiction treatment-particularly for the 32 million previously uninsured Americans who will gain access as a result.

Treatment for these conditions is recognized as critical to overall health by being included on the list of essential benefits that must be covered in new plans offered to the uninsured.

'This health care reform legislation marks a tremendous step forward in our efforts to improve access to care for individuals with mental health or substance use conditions and in our advocacy for prevention of these conditions,' said David Shern, Ph.D., president and CEO of Mental Health America.

The groundbreaking achievement last year with the enactment of the 'Mental Health Parity and Addiction Treatment Act' (MHPAEA) firmly established that discriminatory limits on mental health and substance use conditions will no longer be permitted. Mental Health America is pleased to see the health care reform legislation carries this principle forward and extends the MHPAEA requirements beyond current law to health insurance plans offered to small businesses and individuals. These principles are also reflected in the expansion of Medicaid which would require those newly eligible to receive mental health and substance use services at parity with other benefits.

Access to care will also be improved due to insurance market reforms in this new law that will prohibit pre-existing condition exclusions, rescissions of coverage when people most need it, pricing premiums based on health status, and annual and lifetime limits on benefits.

The health care reform law will also establish a new requirement that coverage for dependent children must be available up to age 26 and will provide additional funding for school-based health clinics. Both provisions are critical in light of the fact that mental health conditions often strike during the adolescent and young adult years but most will not receive treatment until many years later, if at all.

Mental Health America places a high priority on prevention, particularly among children and youth, and thus we are please with the new requirements to cover preventive services as well as programs to support community-based prevention activities.

'We also strongly support the provision in this law that will eliminate the donut hole in the Medicare prescription medication coverage as Medicare is a crucial source of support for millions of people with behavioral health conditions,' Dr. Shern said.

Among the many other important new programs and reforms are initiatives to support education and training of additional mental health and addiction treatment providers and to improve coordination of care through a new state option for medical/health homes in Medicaid that includes individuals with serious mental health conditions among the priority populations.

Health America Sets its Sights on Pennsylvania's Aetna Health Plans.(Originated from Pittsburgh Post-Gazette) - Knight Ridder/Tribune Business News

Dec. 9--Health America, the region's second largest managed care insurer,

is in negotiations that could lead to the purchase of Aetna Health Plans of Western Pennsylvania.

The transaction would give a boost to Health America's membership growth,

which flagged last year in the face of a massive campaign by Blue Cross of Western Pennsylvania to invade the managed-care market, a source familiar with the discussions said.

Depending on terms of the deal, it could also give Health America, whose Nashville-based parent, Coventry Corp., operates in eight states, a reciprocity agreement or joint-marketing relationship with Aetna Health Plans, whose Connecticut-based parent corporation is shifting its insurance business away from property and casualty products and into health care.

A reciprocity arrangement here, if it is established along with a sale, would enable Aetna to serve corporate clients in the Western Pennsylvania market, which it has been unable to crack. Aetna's efforts to sell its operations in this region have been rumored for months. Among other attempts,

it discussed a possible sale to the University of Pittsburgh Medical Center, which has since set its sights on acquiring Best Health Care, a health maintenance organization that is in the process of getting state licensure.

Aetna's ranking officer here, Steve Jones, could not be reached for comment on the talks, and Health America declined comment.

But health-care industry analysts said a sales agreement would make sense, particularly if it includes joint marketing.

'I think it's probably a good move for Health America,' said Jere Cowden,

an industry consultant. 'Obviously, they're hoping to expand their market share.'

Until last year, Health America was the region's largest managed-care insurer -- with about 250,000 members in its plans -- and had been chalking up annual membership growth at double-digit rates. But growth slowed to about 6 percent in the first half of 1995, after it lost a couple of high-profile accounts, including the University of Pittsburgh, to Blue Cross. Blue Cross,

which came late to the managed-care market, has since claimed first place in it, with some 500,000 members. The slowdown for Health America helped lead to layoffs and a change in top management earlier this year.

Aetna has been running a distant fourth in the region's managed-care market race, with roughly 23,600 in its Western Pennsylvania plans as of the end of last year.

Aetna, on its own, 'was never really successful here,' said Dan O'Malley,

STATEMENT OF MENTAL HEALTH AMERICA ON REGULATIONS IMPLEMENTING WELLSTONE-DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT. - States News Service

ALEXANDRIA, VA -- The following information was released by the Mental Health America:

Mental Health America applauds the release of the regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. We greatly appreciate all the thoughtful work that the staff and leaders of the three agencies charged with implementing this law put into developing these regulations. They clarify a number of key issues that will greatly help to ensure the intent of the parity law- to prohibit discriminatory treatment of mental health and substance use conditions-is fully realized and implemented.

These regulations clarify that the Wellstone-Domenici parity law prohibits plans from discriminating against mental health and substance use treatment in application of medical management, prescription formulary design, standards for provider admission into preferred provider network, determination of usual and customary amounts of care, and fail first or step therapy requirements. This clarification is extremely important since these discriminatory practices are widespread and pernicious. The regulations also underscore that obvious quantitative limits on treatment, like restrictive limits on number of visits, annual or lifetime caps, co-payments for service are clearly outlawed.

The reglations clarify that plans may not impose separate deductibles and financial restrictions on mental health and substance use services but must accumulate deductibles across medical treatments. Similarly, the regulations specify that mental health and substance use services cannot be treated as a special class of specialty services and managed differently than primary care treatments. Mental Health America has received reports that some plans are still imposing these kinds of separately accumulating limits on mental health and substance use care. We are pleased that the departments charged with implementing the law reiterate a clear requirement in the statute that hopefully will clear up any confusion in this regard.

Mental Health America's comments in response to the Request for Information issued by the three agencies last spring emphasized the importance of addressing these issues in the regulations. We are very pleased to see these concerns were addressed in the regulations.

Mental Health America will be working with our over 300 affiliates to provide additional input on several outstanding issues for which the government has requested comment.

A fact sheet on the law can be viewed here.

Mental Health America is the country's leading nonprofit dedicated to helping all people live mentally healthier lives. With our century of service to America and our more than 300 affiliates nationwide, we represent a national movement that promotes mental wellness for the health and well-being of the nation- everyday and in times of crisis.

Mental Health America Hails Enactment of Historic Health Care Reform Bill. - Managed Care Weekly Digest

Mental Health America today hailed the 'Patient Protection and Affordable Care Act' signed by the President today. The legislation will greatly expand access to mental health care and addiction treatment--particularly for the 32 million previously uninsured Americans who will gain access as a result (see also Mental Health America).

Treatment for these conditions is recognized as critical to overall health by being included on the list of essential benefits that must be covered in new plans offered to the uninsured.

'This health care reform legislation marks a tremendous step forward in our efforts to improve access to care for individuals with mental health or substance use conditions and in our advocacy for prevention of these conditions,' said David Shern, Ph.D., president and CEO of Mental Health America.

The groundbreaking achievement last year with the enactment of the 'Mental Health Parity and Addiction Equity Act' (MHPAEA) firmly established that discriminatory limits on these conditions will no longer be permitted. Mental Health America is pleased to see the health care reform legislation carries this principle forward and extends the MHPAEA requirements beyond current law to health insurance plans offered to small businesses and individuals. These principles are also reflected in the expansion of Medicaid which would require those newly eligible to receive mental health and substance use services at parity with other benefits.

Access to care will also be improved due to insurance market reforms in this new law that will prohibit pre-existing condition exclusions, rescissions of coverage when people most need it, pricing premiums based on health status, and annual and lifetime limits on benefits.

The health care reform law will also establish a new requirement that coverage for dependent children must be available up to age 26 and will provide additional funding for school-based health clinics. Both provisions are critical in light of the fact that mental health conditions often strike during the adolescent and young adult years but most will not receive treatment until many years later, if at all.

Mental Health America places a high priority on prevention, particularly among children and youth, and thus we are please with the new requirements to cover preventive services as well as programs to support community-based prevention activities.

'We also strongly support the provision in this law that will eliminate the donut hole in the Medicare prescription medication coverage as Medicare is a crucial source of support for millions of people with behavioral health conditions,' Dr. Shern said.

Among the many other important new programs and reforms are initiatives to support education and training of additional mental health and addiction treatment providers and to improve coordination of care through a new state option for medical/health homes in Medicaid that includes individuals with serious mental health conditions among the priority populations.

Mental Health America is the country's leading nonprofit dedicated to helping all people live mentally healthier lives. With our century of service to America and our more than 300 affiliates nationwide, we represent a national movement that promotes mental wellness for the health and well-being of the nation-- everyday and in times of crisis.

Keywords: Addiction Medicine, Health Insurance, Health Policy, Insurance, Medicaid, Mental Health, Pediatrics, Mental Health America.