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New Hampshire
and Vermont still seek parity in spite of laws
(June
2008 Issue)
By Phyllis Hanlon
While the issue of parity has made important strides nationwide,
some New England states still face challenges in enforcing the law.
Michael J. Cohen, MA, CAGS, executive director of NAMI-NH cites
several shortcomings in his state's parity law. "The law is not
comprehensive enough. It doesn't cover anything outside the V codes.
Services to kids and adolescents are limited unless they have a
diagnosable illness. Addictive diagnoses are not covered," he says,
"but the real controlling factor is the insurance company and how
they manage care. The major issue is how to get insurance companies
to provide comprehensive, reasonable coverage."
Cohen does not foresee any changes to the current law unless "a
large constituent group gets together and pushes." He points out
that NAMI will not tackle the issue alone but would like to be part
of a coalition. "Ideally, like the law in Vermont, we'd work with
the psychological association in the state," he says.
Kathryn E. Saylor, Psy.D., executive director of the New Hampshire
Psychological Association, says that she and Cohen participate in
the N.H. Mental Health Coalition, which works to improve the quality
of mental health care in the state. Saylor, who chairs the coalition,
indicates that the parity issue will be discussed at an upcoming
meeting.
New Hampshire's insurers offer similar behavioral health coverage.
Christopher R. Dugan, director of communications and community relations
for Anthem Blue Cross and Blue Shield in New Hampshire, says, "Unless
the benefit plan states otherwise, we allow 12 outpatient visits/sessions
per year before a clinical review is required." He adds that as
long as treatment is medically necessary, no cap or limit will be
imposed on either inpatient or outpatient therapy.
Anthem's criteria for "medical necessity" incorporate guidelines
from all the major behavioral associations, according to Dugan.
The term refers to health care services or products provided to
prevent, stabilize, diagnose or treat an illness, injury, or disease
and/or its symptoms according to the best practices in the medical
profession.
Douglas Nemecek, M.D., senior medical director for CIGNA's health
solutions unit, reports that CIGNA requires no prior authorization
for routine outpatient services. Typical CIGNA plans allow up to
60 outpatient visits in one calendar year; some CIGNA plans impose
no limits. Inpatient visits in some plans are unlimited, but others
restrict inpatient treatment to 30 to 60 days, he adds.
"However, we do focus on quality of care and take steps to ensure
our members are receiving appropriate evidence-based treatment,"
Nemecek says. CIGNA emphasizes that care should be "safe, effective,
patient centered, timely, efficient and equitable."
CIGNA also monitors claims and works to identify optional treatment
if a member's benefits are nearly exhausted.
In Vermont, NAMI-VT, Vermont Psychiatric Survivors and the National
Association of Social Workers-Vermont conducted a joint unscientific
survey to assess barriers to access. Respondents, which included
providers, family members and consumers/advocates, ranked insurance
coverage, long wait times and transitional services as the top three
issues. Top priorities included increasing funding; closing loopholes
to the parity law; providing better access to voluntary treatment;
diverting non-violent offenders from prison into treatment; offering
more supportive and affordable housing options and integrating physical
and mental health care with substance abuse treatment.
According to Linda J. Corey, M.S., director of Vermont Psychiatric
Survivors, the state has attempted to address some of these problems,
but with little help from legislators. "Services keep getting chopped
out," she says. "It's hard to get services before being in a heightened
crisis stage."
Corey cites one program that has proven successful. For the last
10 years, Vermont has had a six-bed licensed house in which a peer
group collaborates with a mental health agency. She says, "We see
a lot of prevention with peer-to-peer support groups. They are cost
effective and will help a lot as time goes on."
A proposed new peer-run crisis program could help those looking
for "a getaway to refocus," but who don't need medical care. Corey
says, "If we had a place to regroup, people could work on recovery,"
noting that this type of setting would not replace a group home.
Funding still remains the key piece though. Corey says, "What program
do we take money from? At this point there is not a lot, if anything,
in the slush fund to help. It's a balancing act."
Several legislative leaders and committee chairs received the survey
results prior to voting on the state budget, according to Larry
Lewack, executive director NAMI-VT. "Lawmakers have the power of
the purse. If they're aware of gaps, they can make informed decisions,"
he says.
Lewack adds that the survey serves as a "strong seam" to "raise
the level of debate and help the Senate go forward." He also views
the survey as a backup to ensure payment for providers.
Lewack does not personally object to the notion of managing mental
illness, but believes there is room for improvement. "There can
be benefits to the subscriber and the insurance company to work
together on treatment to get better results and control costs,"
he says.
According to Ken Libertoff, executive director of the Vermont Association
for Mental Health, things might be looking up with the unanimous
passage of S.114 on March 19, which enhances access to mental health
services and limits the use of carve-outs.
The Vermont Psychological Association (VPA) initiated the birth
of S.114 and has been "the driving force behind it," according to
Rosanna Czermak, VPA's executive director. Alexandra Forbes, VPA's
legislative chair, invited NAMI-VT to collaborate and together they
promoted the bill.
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