The political will for health care reform remains strong according to Speaker of the House Nancy Pelosi. President Obama also urges Congress to continue its work on reform. There are several options under consideration for passing reform, including having the House pass the Senate bill and agreeing to changes through reconciliation. Reconciliation could allow passage with a 51 vote majority in the Senate. Additionally, guidance on implementing the 2008 Mental Health Parity and Addiction Equity Act was released, applying to employer plans of 50 or more employees.

1. www.TheNationalCouncil.org
Health Care Reform Update
February 1, 2010
Charles Ingoglia
Vice President, Public Policy

2. www.TheNationalCouncil.org
The Political Will to Continue with
Reform is Strong
“We’ll go through the gate. If the gate’s closed, we’ll go over the fence. If
the fence is too high, we’ll pole-vault in. If that doesn’t work, we’ll
h f h h ll l l f h d k ll
parachute in. But we’re going to get health care reform passed for the
American people, for their own personal health and economic security,
and for the important role that it will play in reducing the deficit ”
deficit.
– Speaker of the House Nancy Pelosi
President Obama urges Congress to continue its work on reform…
reform
“Let us find a way to come together and finish the job for the American
people. Let's get it done.”

3. www.TheNationalCouncil.org
But We Need to Remind our Elected
Officials that We Support Reform
Last week: Over 200 email messages sent to
Congress from National Council members
Go to: http://capwiz.com/thenationalcouncil/home/
This week: Sign on letter to the President
Email

4. www.TheNationalCouncil.org
The Road Ahead
Several options still being considered:
House passes Senate bill; Senate agrees to a
package of changes that can be passed
through reconciliation
Scale back bills to only include provisions that
have b d support
h broad t
Eliminate non-budgetary provisions so the
entire bill can be passed through reconciliation

5. www.TheNationalCouncil.org
Reconciliation Process
Bills considered through this process:
Are limited to spending and/or tax issues
Cannot add to the federal deficit
Only need 51 votes in the Senate
There have been 19 bills passed through reconciliation and
signed into law since 1980 including:
The Welfare Reform Act -1996
1996
CHIP - 2008
Tax cuts - 2001 & 2003
COBRA – 1985
** CBPP: “Using Reconciliation Process to Enact Health Reform
Would be Fully Consistent with Past Practice”
http://www.cbpp.org/files/1-26-10health.pdf

6. www.TheNationalCouncil.org
Guidance Released on
Implementation of Mental
Health and Addictions Parity

7. www.TheNationalCouncil.org
Background
• Paul Wellstone and Pete Domenici Mental Health
Parity and Addictions Equity Act passed on Oct. 3,
2008
• Required equity in coverage for MH/SU and
medical/surgical benefits
• Applied to group health p
pp g p plans of 50 or more
employees and Medicaid managed care
• Instructed the Depts. of Health & Human Services,
Education, d L b t i
Ed ti and Labor to issue regulations providing
l ti idi
guidance on implementation

8. www.TheNationalCouncil.org
Jan. 29, 2010: Interim Final Rule
Released
> IFR goes into effect on April 5, 2010
> Applies to insurance plans with plan years
starting on July 1 or later
> Comment period open through May 3, 2010
> IFR published in the Federal Register on
Feb. 2, 2010 (http://www.gpoaccess.gov/fr/)

9. www.TheNationalCouncil.org
Who Must Comply with the
IFR
> Group insurance plans with more than 50
employees
> This IFR does NOT apply to Medicaid
Managed Care
> G id
Guidance on h M di id M
how Medicaid Managed C d Care
plans should implement parity will be
released by HHS at a f t
l db t future date
d t

10. www.TheNationalCouncil.org
Scope of Services
• IFR divides benefits into 6 classifications:
1. Inpatient, in-network
2. Inpatient, out-of-network
3.
3 Outpatient, in network
Outpatient in-network
4. Outpatient, out-of-network
5. Emergency care
g y
6. Prescription drugs
• Plans that offer MH/SU services in a
classification must offer them at parity with
l ifi ti t ff th t it ith
medical/surgical benefits in that classification

11. www.TheNationalCouncil.org
Limits on Use of Services
• Distinguishes between “quantitative” and “non-
quantitative” limits
• “Q
“Quantitative”= limits on dollar value of benefits,
i i ” li i d ll l f b fi
number of visits, other benefits with a numerical value
• “Non-quantitative” = medical management services
q g
such as:
– Prescription formulary design
– “Fail-first” or step therapies
Fail-first
– Prior authorization
• The IFR expressly prohibits non-quantitative limits,
unless similar limits exist for medical/surgical
l i il li it i tf di l/ i l
benefits

12. www.TheNationalCouncil.org
Cost Sharing / Financial
Requirements
> No separate deductibles for MH/SU and
medical/surgical benefits
> No separate co-pay requirements
co pay
> No separate out-of-pocket limits
> Deductibles, copays, and out-of-pocket
limits must be integrated and cumulative
for all services

13. www.TheNationalCouncil.org
Exemptions
• Insurance plans may be granted a 1-year
exemption if they experience total increased
costs of 2% in the first year after
implementation and 1% in subsequent years
– Criteria for this exemption not included in IFR
– they will be issued at a later date
• U d HIPAA non-federal government plans
Under HIPAA, f d l t l
(e.g. state and local govt. plans) may seek a
waiver to opt out of certain federal
p
requirements

14. www.TheNationalCouncil.org
President’s FY11 Budget
Released Feb 1
$23M to IHS for comprehensive substance abuse
prevention services
Early risk factors
$56M for drug courts
$23M for re-entry programs
Level funding for mental health and substance abuse
block
bl k grant programs
t
$25.5B for 6-month extension of FMAP Increase

15. www.TheNationalCouncil.org
FMAP Extension
Included in President s FY11 budget
President’s
Included in the House healthcare reform bill
Included i H
I l d d in House Jobs bill
J b
Effort to have it included in the Senate Jobs
bill

16. www.TheNationalCouncil.org
Next Healthcare Reform
Update Webinar
Save th D t February 16th, 1
S the Date: F b 1pm EST

17. www.TheNationalCouncil.org
National Council for Community
Behavioral Healthcare
www.thenationalcouncil.org
ChuckI@thenationalcouncil.org