Health reform implementation

President Obama on Wednesday welcomed the arrival of some of the most significant and widely anticipated insurance reforms in the Democrats' new healthcare law: the Patient's Bill of Rights.

Those protections — which take effect Thursday, six months after the law passed — represent "the most important patient's bill of rights that we've ever seen in our history," Obama told a small backyard audience in Falls Church, Va., just outside of Washington.

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Lawmakers and mental health advocates said Wednesday that the U.S. has a long way to go before mental and physical health are treated on an even keel.

They called on Congress to pass several pending bills and on federal regulators to implement the new healthcare reform law with an eye towards mental health parity. The comments came during a policy forum sponsored by AstraZeneca and hosted by The Hill.

Rep. Paul Tonko (D-N.Y.), a first-term congressman who helped pass a mental health parity law in Albany, said there were "four keys to a successful implementation of healthcare reform for the mentally ill and for people with serious addiction disorders":

- The Centers for Medicare and Medicaid Services "must mount a vigorous outreach and enrollment program";

- Regulators must ensure parity in state exchanges and Medicaid and quickly issue guidance regarding parity in Medicare managed care plans;

- Intensive community based services and residential addiction services should be included in the mandatory minimum benefits package offered through the new state exchanges;

- Community mental health centers must be part of every medical home funded via the law's Health Home State Option.

Tonko also raised the issue of Medicare reimbursement cuts to psychiatrists, psychologists and social workers, and with state budget cuts for mental health programs.

Rep. Tim Murphy (R-Pa.), a child psychologist, pressed for passage of legislation that would extend federal health information technology incentives to behavioral health services. The legislation, introduced by Rep. Patrick Kennedy (D-R.I.), would make behavioral and mental health providers eligible for federal grants to acquire electronic health records that are interoperable, integrated, intelligent and easy to use.

But bills improving access to mental health services "only matter if we make sure we integrate care together," Murphy said. "Mental health services are not stand-alone and that is something we need to continue to educate the community around."

Murphy also said his bill extending federal medical liability protections to volunteers at community health centers might come up for a vote Wednesday.

Linda Rosenberg, the president and CEO of the National Council for Community Behavioral Healthcare, also pressed for passage of Kennedy's bill and for "vigilance in ensuring that the Affordable Care Act’s Health Home State Option meets the needs of people with serious mental illness."

She also requested support for the Community Mental Health and Addiction Safety Net Equity Act, which would replace community mental health centers with Federally Qualified Behavioral Health Centers - entities designed to serve individuals with serious mental illnesses and addiction disorders. The bill, introduced by Rep. Doris Matsui (D-Calif.), has six co-sponsors.

Federal regulators have agreed to give some health plans until July 1, 2011, to comply with internal appeals and external review rules set to go into effect Thursday.

New "safe harbor" guidance from the departments of Labor and Health and Human Services delays enforcement action against group health plans and health insurance issuers in the group or individual market who are "acting in good faith" to implement the new rules, created by the healthcare reform act. The plans, according to a memo to members of America's Health Insurance Plans (AHIP), must show they are doing their best to: 

• respond to urgent-care claims within 24 hours after receipt of the claim; 
• provide notices in a "culturally and linguistically appropriate" manner;
• include diagnosis and procedure codes and other content on notices of adverse determination; and
• allow claimants to initiate external review or legal action if the plan or insurer fails to strictly adhere to all requirements.

AHIP had requested the safe harbor out of concern that health plans would face "significant challenges" in complying with the new rules by Thursday. 

In addition, the new guidance also addresses grandfathered plans, dependent coverage for children up to age 26 and coverage for out-of-network emergency services.

Dems, consumer groups welcome Patient's Bill of Rights: Six months ago tomorrow the Democrats passed their healthcare reform bill into law — an anniversary most significant for the arrival of many of the insurance reforms that were central to the mammoth bill.

On Wednesday, President Obama will mark the imminent anniversary by meeting with a handful of patients benefiting from the changes, including a previously uninsured New Hampshire woman with non-Hodgkin's lymphoma who's now enrolled in a high-risk insurance pool.

The White House this week also plans to release reports indicating how the reforms will affect each state, and to launch an overhauled website (www.WhiteHouse.gov/HealthReform) detailing the changes.

The reforms taking effect Thursday will:

• Ban insurance companies from denying coverage for kids based on preexisting conditions. (In 2014, this rule will be expanded to apply to patients of all ages.)

• Prohibit insurers from using unintentional application errors to drop coverage when patients get sick.

• Allow young adults to remain on their parents' health plans until age 26.

• Prohibit plans from setting lifetime dollar limits on coverage. (In 2014, annual limits will be banned as well.)

• And require all new health plans to cover a minimum set of preventive care services.

All but the last provision apply to all insurance plans, even those in existence when the law was enacted in March.

Good news for MA patients, taxpayers: Tuesday's news that Medicare Advantage (MA) plans will offer more benefits next year at a lower cost to patients brought cheers from a group that's been critical of the program since its inception seven years ago: liberal Democrats.

"Medicare Advantage beneficiaries will actually get more benefits from their plans, not less," Rep. John D. Dingell (D-Mich.) said in a statement. "And the insurers are not suffering because of the changes – they are gaining new enrollees."

The figures fly in the face of reform critics who'd warned that requiring MA plans to cover additional benefits would inevitably cause premiums to jump. Instead, Medicare officials were able to leverage the bulk-purchasing power of more than 11 million MA beneficiaries to negotiate lower costs for the same folks. Read more...

President Obama will drop by an administration meeting with state insurance commissioners on Wednesday ahead of his comments on the six-month anniversary of healthcare reform. Topics under discussion will include health insurance rate review, the definition of what constitutes "unreasonable" rate increases and the medical loss ratio, senior administration officials said.

The medical loss ratio conversation could be especially important, one policy analyst notes, because the National Association of Insurance Commissioners subpanel tackling the issue is expected to release draft legislation by Monday. The NAIC is set to vote on the regulation next month following a public comment period.

The administration does not want to publicly override the commissioners, the analyst said, so it makes sense to iron out any differences before the commissioners send their product to the secretary of Health and Human Services for certification. Last month, the chairmen of the House and Senate committees of jurisdiction over healthcare said only that taxes pertaining to the healthcare reform law should be excluded when calculating the ratio; the NAIC is leaning in the direction of excluding many more taxes, which means health plans wouldn't have to spend as much on care to meet their medical loss ratio requirements under the new law.

But NAIC President Jane Cline tells The Hill that the administration has not weighed in on the tax piece of the ratio. Cline, the West Virginia insurance commissioner, added that she does not expect the White House to do so Wednesday.

Administration officials, she said, "have been very respectful of our work."

"They recognize that it's important that we get the medical loss ratio definitions to them as soon as possible so that they have the opportunity to put forward their regulations and the industry knows what is expected of them," she said.

Under the health reform law, large group plans must spend at least 85 percent of premium dollars on care; plans in the small group and individual market have an 80 percent requirement. The provision applies to plan years starting in 2011, with rebates to consumers beginning in 2012.

"Plain and simple, insurance companies can't be trusted," Ways and Means health panel Chair Pete Stark (D-Calif.) said Tuesday in the latest salvo after health plans announced they were dropping their children's coverage.

Several major insurance companies — including WellPoint, Cigna and CoventryOne — have decided to stop issuing children's policies just days before the start of new rules forbidding them from turning down sick children. The prohibition is among several provisions of the healthcare-reform law that kick in Thursday and that Democrats plan to highlight ahead of the midterm elections.

Democrats are especially galled by the announcement because the industry's lobbying arm, America's Health Insurance Plans, had appeared to support the measure.

"Six months ago, the insurance industry trade association promised that their members would 'fully comply' with the provision in the health reform law outlawing discrimination against children with pre-existing conditions, " Stark said in a statement. "Now with this consumer protection about to go into effect, we find out they didn't really mean it. The insurance industry has once again shown their reckless disregard for the well-being of consumers, which is why we need the health reform law that holds them accountable."

Health insurers dropping children-only plans: Just days before new rules take effect banning insurers from denying coverage to sick kids, a number of companies have decided to drop some policies catering only to kids — a move health-reform supporters are blasting. 

"We’re just days away from a new era when insurance companies must stop denying coverage to kids just because they are sick, and now some of the biggest changed their minds and decided to refuse to sell child-only coverage," Ethan Rome, executive director of the liberal group Health Care for America Now, said in a statement. "The latest announcement by the insurance companies that they won't cover kids is immoral, and to blame their appalling behavior on the new law is patently dishonest." 

Earlier in the year, insurers had criticized the prohibition on excluding kids with pre-existing conditions, arguing that parents would simply wait until their kids got sick to enroll them in coverage. The White House responded by allowing the companies to establish limited enrollment periods, as long as they comply with state law.  

The move by some insurers to drop children-only plans is an indication that the open-enrollment compromise wasn't convincing enough for some companies. http://bit.ly/aX6Uy4 

Dems unveil global drug-safety bill: Leaders of the House Energy and Commerce Committee on Monday released draft legislation designed to ensure the safety of pharmaceuticals in an ever-globalizing world. Presented by Reps. John Dingell (D-Mich.), Henry Waxman (D-Calif.), Frank Pallone (D-N.J.) and Bart Stupak (D-Mich.), the proposal is designed to inspire a discussion about America's role in policing the international companies making the drugs that eventually find themselves to U.S. drugstores. 

The issue grew prominent in 2008 when defective, Chinese-made heparin, a blood thinner, killed scores of Americans. 

"We’ve learned more than a few troubling truths on the safety of some prescription medications, and we’ve learned it the hard way — with tragedies,” Dingell said in a statement. "We know we need to address this, the only question now is how. We must ensure the Food and Drug Administration is adequately equipped to carry out the important mission of protecting American consumers." http://bit.ly/97oNaq 

Health plans in at least four states have announced they're dropping coverage days ahead of the new law's requirements.

GOP leaders on the Senate Finance Committee are calling for the panel to take a closer look at what's causing the recent wave of insurance premium increases. 

Sens. Chuck Grassley (Iowa) and Pat Roberts (Kan.) say the hearing will shed light on how extensively the new health reform law is driving the premium hikes.

"[A] recent article in the Wall Street Journal reported that some health plans will be raising premiums between 1 and 9 percent in the next plan year as a direct result of changes in the health reform law," the Republicans wrote last Friday in a letter to Finance Chairman Max Baucus (D-Mont.). "Others, including Secretary Sebelius, have predicted much lower increases.

"A public hearing would provide an opportunity to sort through these different estimates and review the changes affecting premiums."

The GOP leaders have specifically requested testimony from Jay Angoff, director of the Office of Consumer Information and Insurance Oversight, and Richard Foster, chief actuary at the Centers for Medicare and Medicaid Services.  

"Mr. Angoff should be made available to provide information about trends in the current health insurance marketplace while Mr. Foster should discuss some of the underlying issues and cost drivers behind health care inflation," the Republicans wrote. 

Federal regulators face a tough choice on contraception as they finalize the rules for coverage of preventive services under the healthcare reform law.

The law requires that, starting Thursday, new health plans cover preventative care benefits without deductible, co-pay or coinsurance. The administration unveiled regulations implementing the provision two months ago, and stakeholders had until midnight on Friday to comment.

Back in July, regulators deferred a decision on "preventive care and screening" services specifically for women until August of 2011, prompting Planned Parenthood to declare that it would press for coverage of "all forms of FDA-approved prescription contraception." Stakeholders revisited the issue in their latest filings.

The U.S. Conference of Catholic Bishops raises three main concerns in its objections to coverage of contraception: 

- Family planning is not disease prevention;

- While preventive services are often low-risk options aimed at avoiding risky consequences later, contraceptives can have the opposite profile; and

- Mandating contraception or sterilization coverage poses a threat to the rights of conscience of religious employers and others.

"To prevent pregnancy is not to prevent a disease — indeed, contraception and sterilization pose their own unique and serious health risks to the patient," the group writes. "In addition, contraceptives and sterilization are morally problematic for many stakeholders, including religiously-affiliated health care providers and insurers."

Montana's commissioner of securities and insurance, however, wrote to urge mandatory coverage of "the full range of women's preventive health care needs, including family planning."

"Pregnancy is an expensive proposition and prevention of unplanned pregnancy is highly cost effective," writes Commissioner Monica Lindeen. "For every public dollar invested in contraception, nearly $3.75 is saved in Medicaid expenditures that would have been needed for prenatal care, labor and delivery, postpartum care, and the infant's first year of medical care.

"In addition, the costs of complications can be very high. Women with unplanned pregnancies have more complicated pregnancies and deliveries on average due to increased likelihood of inadequate prenatal care, exposure of the fetus to harmful substances, and low birth weight."

On another note, the National Assembly on School-Based Health Care is urging regulators to ensure students' confidentiality. Plans are required to issue explanations of benefits to policyholders — often a parent or guardian — when paying a healthcare provider, and this can be a problem for sensitive services such as family planning, screening and counseling on sexually transmitted diseases, mental health and substance abuse services.

The American Heart Association also has a host of recommendations, mostly aimed at broadening the scope of services that must be covered without co-pays.