Controversial Health Insurance Reform Forum

I had the opportunity to be invited by Congressman McGovern's office to attend the Health Insurance Reform Forum at the University at Massachusetts Medical School today, 8/4/09 from 330-5 PM. Besides getting a lost due to poor logistics on finding the appropriate amphitheater and being appalled by the lack of adequate handicap accessibility for persons with disabilities, this forum achieved some of its goals in explaining the nuts and bolts on the proposed health insurance reform that is currently sitting in Congress.

The room was full and standing room only. Fortunately, I followed a few people to the platform level where I was able to hear the speakers and not see them. Later on, I was told to go to the fourth floor amphitheater where I was able to sit in an air conditioned room and see the speakers on the screen.

Some of the participants in the audience were loud, rude and disrespectful toward both Congressmen Richard Neil (from Springfield) and James McGovern and to each other. An UMass official told the audience that if those participants did not clamp down and stop their heckling, that both Congressmen would be escorted from the room and the forum would end.

After the brief 15 minute fray, things quieted down and both speakers were able to present their support of health insurance reform. Here are some of the points on why they both support changes:

1) The current system of health care is broken
2) The status quo is not working
3) 16% of Gross Domestic Product(GDP goes to healthcare costs; by 2040, health insurance costs will be 50% of the GDP. If this becomes the cost, the federal government will have difficulties paying for education and other costs that are important for Americans to have.
4) Drug costs are increasing exorbitantly.
5) The donut hole in Medicare is unaffordable for many seniors and for persons with disabilities

Here are some points that were clarified and supported by both speakers for health insurance reform:

1) The current Bush medicare "donut hole" for seniors would be changed. Currently, the Department of Health and Human Services (HHS) is forbidden under federal law to negotiate drug prices with drug companies. If bill is passed and would be effective in 2013, HHS would be able to negotiate for lower drug costs.

2) The myth or misunderstanding that patients would be mandated to have "End of Life Care" discussions with their doctors is false. Both speakers emphasized that these discussions are voluntary and the doctors will be able to get reimbursed for their time with their patients. It was noted that End of Life care is very expensive in particular for a young 25 old male (as an example) who gets into a motorcycle accident and has no health insurance to cover his costs. This position sort of makes sense to me as I understand why "the morphine" is sometimes pushed with hospice patients to get them of their misery. If they on Medicaid, it is cheaper to end their life sooner, as a cost-saving mechanism for the government. I also understand that this issue is controversial and very taxing and emotional for some family members to deal with.

3) If you have your insurance plan and like it, you can keep it. A participant yelled out, "How long?" Both speakers emphasized that nothing would change for them if they like their health insurance plans.

4) Incentives would be given for doctors to enter the primary care field as there is a current shortage of them throughout the country. The same is for increased recruitment of nurses for the same current economic conditions.

5) Increase emphasis will be on promoting and using evidence based practices to reduce costs and increase quality for patient care. An Independent Board of physicians and experts would conduct studies to evaluate the cost effectiveness of using evidence based practices that are not influenced by drug companies and special interest groups.

6) Overall, the gist of health insurance reform is to promote prevention, to increase responsibility on the individuals to purchase health insurance, and to improve the quality of care using cost-effectiveness evidence-based practices in reducing costs to the government and to taxpayers. To do nothing as both speakers stress, will result in higher taxes for Americans and maintain the status quo.

What do you think?


Robbin Miller, LMHC
Citizen-Therapist
www.robbinmiller.vpweb.com

Calling a Person with a Disability an Inspiration:Is this an inappropriate comment?

As an advocate, I am not comfortable when the general media calls a person with a disability "a story of inspiration" and " accomplishing a heroic feat." These terms in my opinion are offensive and actually put down a person with a disability. A friend of mine who has a mobility impairment said that a person with a disability is either looked at as a "hero" or "as shit" by the community. She said an individual with a disability needs to be looked in the "middle" as a person just like anyone else who does not have a disability.

How about if articles labeled a person without a disability as a TAB-Temporarily Abled-Person when writing about their issues in the general media? How would the community respond to this?

Many healthcare professions also believe that motivating their clients to arise above their disabilities by performing "extradordinary" feats will make them feel better. This is wishful thinking and can actually cause more harm than good. What about if this person does not accomplish this "feat' than what?

I have been actively advocating that "Disabilities" become part of the "Committee on Healthcare Disparities" for minority groups in Massachusetts. At press time, I don't if this legislation was pass to include "Disabilities" as part of this committee.

What do you think?

Robbin Miller, LMHC
Facilitator
http://www.robbinmiller.vpweb.com/

Promoting Your Private Practice

If it is true, we are in a deep recession, I ask my fellow colleagues on what they are doing to stay afloat and to grow their business?

Some new ideas emanating from the profession are the following marketing tips:

1) Take advantage of the internet in promoting your business. Form an Yahoo or Google group to attract clients. Also, being involved with a social network group like Facebook and Twitter may help promote your business.

2) Participate in committee work for social causes in your local communities to get your name out there.

3) Write articles on different topics pertaining to psychosocial issues affecting the general community in journals; blogs; magazine, etc. for potential clients to hear about your work.

4) Attend networking events with colleagues and business owners from different professions.

5) Offer free workshops to "enroll" potential clients.

What other ideas are you currently doing to build your practice?

How about the new concept of offering online counseling? A potential market that can be tapped into quite soon.

Robbin Miller, LMHC
Facilitator
http://www.robbinmiller.vpweb.com/

Obama's Proposal for Health Insurance Reform: What do You Think?

President Obama made his speech to the nation tonight stating that health insurance reform will provide health care to every American who needs it. Obama said that the public health insurance program will create competition with the private sector commercial insurance companies for the American people to choose from. Obama also said that the deficit would decrease from 7.3 trillion dollars to 7.1 trillion dollars when health insurance reform is passed. As stated earlier this week in several newreports, hospitals have agreed to take cuts in reimbursements for providing free care to individuals who don't health insurance. How will this impact you in terms of preminums being increased to pay for these costs to hospitals? Will America's healthcare insurance reform be like Canada where the healthcare is rationed with long waiting lists to get medical appointments and procedures done for their citizens?

One Republican congressman said that President Obama's plan will ration healthcare due to a new Governmental Bureacracy being formed. This individual also said that his constituents in this North Central state do not want the government taking away their healthcare.

What do you think? Are American people afraid of the changes in how health insurance will be paid for and decided for you by our government?


Robbin Miller, LMHC
Facilitator

New Mental Health Law Parity

Effective July 1, 2009
Massachusetts Mental Health Parity Law

1. What is the Massachusetts Mental Health Parity Law?
The Massachusetts Mental Health Parity Law requires insurers who offer mental health benefits to cover the diagnosis and treatment of certain mental disorders to the same extent that they cover the diagnosis and treatment of physical disorders. The law makes it illegal for some health insurers to place stricter annual or lifetime dollar or unit of service limitations on coverage of qualifying mental disorders that differ from the limitations on coverage of physical conditions. The law also provides for minimum outpatient and inpatient benefits for those disorders not required to be treated the same as physical ailments.

2. What mental disorders must be given unlimited medically necessary treatment?

The Mental Health Parity Law provides parity for these disorders:“Biologically-based” mental disorders· Schizophrenia· Schizoaffective disorder· Major depressive disorder· Bipolar disorder· Paranoia and other psychotic disorders· Obsessive-compulsive disorder· Panic disorder· Delirium and dementia· Affective disorders· Any other "biologically-based" mental disorders appearing in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (the "DSM") that are scientifically recognized and approved by the Commissioner of Mental Health in consultation with the Commissioner of Insurance Rape-related mental or emotional disorders ·

Mental or emotional disorders in victims of rape, or assault with intent to commit rape, to the extent the costs of diagnosis and treatment exceed the maximum compensation awarded to victims under the Massachusetts law regarding compensation to victims of violent crime. There are special provisions for children. NOTE: Showing the insurance company that the service you want is “medically necessary” is a must, even when the disorder or treatment is covered by the parity law.

3. What special rights do children have?

For children under the 19, the law provides additional safeguards with respect to "non-biologically-based " mental, behavioral, or emotional disorders. These are in addition to the protections for "biologically-based" disorders. Specifically, the law requires health plans to provide coverage to children: For non-biologically-based mental, behavioral, or emotional disorders that substantially interfere with or substantially limit functioning and social interactions, where: The child’s primary care physician, pediatrician, or a licensed mental health professional has made the referral for diagnosis and treatment of the disorder, and has documented the substantial interference or limitation,or ·

The substantial interference or limitation is evidenced by conduct, including, but not limited to (1) an inability to attend school, (2) the need for hospitalization, or (3) a pattern of conduct or behavior that poses a serious danger to self or others. ·

If a child turns 19 while undergoing treatment, the health plan must continue to provide this coverage until the course of treatment is completed and while the benefits contract covering the adolescent remains in effect. The plan is allowed to charge a premium for these extended benefits, if the child's eligibility for coverage would otherwise end at 19.

4. Does the law cover treatment for alcoholism or other chemical dependency?

Massachusetts law requires that coverage of alcoholism and/or chemical dependency treatment include 30 days inpatient care and $500 worth of outpatient benefits. However, when treatment for these problems occurs in conjunction with treatment for mental disorders, the patient is entitled to broader coverage.

5. What is the minimum coverage for disorders that are not on the list of covered disorders?

For mental disorders that are not on the list of disorders eligible for parity, insurers must provide medically necessary coverage during each 12 month period for a minimum of 60 days inpatient treatment and 24 outpatient visits. Carriers cannot impose other limitations or cost-sharing (such as copayments) on treatment for these mental disorders, unless the same requirements apply to physical conditions. Medication visits and neuropsychological testing are not subject to these limits, and must be covered on the same terms as medical services.

6. What health plans must comply with the MHPL?

The Mental Health Parity Law applies to all of these health plans:· Group Insurance Commission ("GIC") plans for government employees and retirees·Plans issued by Massachusetts-licensed commercial health insurers· Blue Cross and Blue Shield of Massachusetts plans·Plans issued by Massachusetts-licensed HMOs· Small group health plans regulated by Massachusetts insurance authorities·Non-group health plans·Student health insurance plans (for higher educational institutions) The following plans do not have to comply with this law:·Self-insured employer group health plans.An employer is self-insured when, instead of paying an insurance company or HMO to cover the health care costs of its employees, the employer itself covers these costs. For more information about your rights in a self-insured plan, call the Department of Labor (regional office) at 617-565-9600 or visit www.dol.gov <http://www.dol.gov/> , or the Attorney General's Insurance Hotline at 1-888-830-6277.·

7. Does the parity law cover outpatient as well as inpatient services?

Yes. The law states that a full range of inpatient, intermediate, and outpatient services shall be available for the treatment of mental disorders, so that treatment may take place in the least restrictive clinically appropriate setting.

8. What is not covered by the parity law?·

Insurers are not required to cover mental health services for persons incarcerated in jail, prison, Department of Youth Services facilities, or other correctional settings. Insurers are not required to pay for those “educational services” that a school must provide as part of its special education program. Note: If there is a medical component to a special education plan, the insurer still should pay for those services which are medically necessary. Insurers are not required to cover services provided by the Department of Mental Health.

If you have questions about the Mental Health Parity Law or you need help getting your insurer to pay for mental health services, please contact: Mental Health Legal Advisors Committee(617) 338-2345 or (800) 342-9092ext. 29
Posted by olddockeller at 12:03 AM

Submitted by Robbin Miller, LMHC