insurance tagged posts

Louisiana is a National Leader with their “Prescriber Prevails” Medicaid Policy

BenNeversBen Nevers
State Senator Louisiana

For the past three weeks we’ve devoted this blog to raising awareness around a proposed regulation by the CMS to restrict access to mental health care. But did you know that individual states have fail first policies as well, through the implementation of their Medicaid programs? Read today’s post to learn if your state is on the list.

Louisiana is a National Leader with their “Prescriber Prevails” Medicaid Policy
Keeps access to medication in the hands of physicians and patients

There are many reasons why people do not receive adequate mental health treatment, each of those reasons is as unique and as highly personalized as the individuals themselves. Yet, nearly all stem from the fundamental problem of access. Access to timely, appropriate, affordable mental health care is too often limited and restricted as a result of the following:

  • a shortage of providers or inpatient beds in a given community
  • insurer restrictions on what, when and how providers can prescribe medication and treatment
  • cost barriers that put mental health care financially out of reach

When such barriers obstruct access to care, more people are at risk for serious, disabling mental illness; and in those cases, society bears the related costs. For that reason, I believe we must work together to address these barriers and expand access to mental health services. The cost of not doing so is enormous.

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CMS, Rescind Your Policy to Restrict Access to Mental Health Care: Our Voices are Being Heard

LarryDrainToday’s CFYM post is all about sharing your personal story. Learn how three DBSA peers traveling to Washington will share your comments from the past two weeks with Congressional Representatives. Read what affect another peer thinks the proposed CMS regulation to restrict access to quality mental health care would have had on his recovery.

For the past two weeks, CFYM has informed our readers on the misguided decision by the Centers for Medicare and Medicaid Services (CMS) to restrict access to quality mental health care. Over the past several weeks since the CMS announced a proposal to eliminate antidepressant and immunosuppressant medications from protected class status, many citizens have taken up the call to make their voices heard. As a result, last week the Senate Finance Committee sent a letter to Marilyn Tavenner, CMS Administrator asking that the regulation be rescinded. All 24 members of the Finance Committee signed the letter. Reporting on the action, BioCentury reported that the letter states “If beneficiaries do not have access to needed medications, costs will be incurred as a result of unnecessary and avoidable hospitalizations, physician visits, and other medical interventions that are otherwise preventable with proper adherence to medication,”

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Why I’m Speaking Out Against the Proposed Medicare Part D Change — And Why You Should, Too

CalabereseJoseph R. Calabrese, M.D.
Director, Mood Disorders Program, University Hospitals Case Medical Center
Bipolar Disorder Research Chair & Professor of Psychiatry, CWRU School of Medicine
Dir., Bipolar Disorders Research Center

This week we are pleased to post the expert opinion of Joseph Calabrese, M.D. on the serious consequences of the proposed regulation to limit access to antidepressant, immunosuppressant and antipsychotic medications for recipients of Medicare Part D. Read the post and take action by participating in the conversation. This enables all of us to share these collective stories with our elected officials through e-mails, letters and in-person visits.

Why I’m Speaking Out Against the Proposed Medicare Part D Change —
And Why You Should, Too

Last month the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would initiate major changes to prescription drug plans under Medicare Part D. These changes would severely limit access to medications that are commonly used to treat serious mental illness and create serious challenges for people who have these mental health disorders.

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Join Us in the Fight to Save Access to Mental Health Treatment: Act Now by Telling Congress You Care!

elderly_handsThe Centers for Medicare and Medicaid Services (CMS) wants to significantly limit access to antidepressant and immunosupressant medication for people subscribing to Medicare Part D. Read today’s post to learn why you should be concerned, and what you can do to support the mental health community by raising our voices in Washington.

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would remove antidepressants and immunosupressants from the protected class status under Medicare Part D and is considering removing antipsychotics from the same status the following year. If CMS adopts its proposal, it would reduce patient access to and the availability of mental health treatment.

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Celebrating the 10-Year Anniversary of the Creation of Medicare Part D

Mary GrealyGrealy Mary Headshot-web
Healthcare Leadership Council

Over the past few months, debate over our nation’s healthcare system has consumed much of the air here in Washington and around the country. The government shutdown over the President’s healthcare law, and the continuing missteps we are seeing with the implementation of the healthcare.gov website have catapulted the issue to the top of mind of many Americans. But regardless of the merits of the debate from either side, so much of the noise and rhetoric has been focused on what is wrong with our healthcare system that we often discard or overlook the elements and programs that are actually working.

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Will Medicare Cover Your Mental Health Care Needs?

old_happy_coupleAnnual enrollment for Medicare ends on December 7, 2013. There has been a lot written about the mental health parity final ruling and the ACA or Obamacare. It is important to note that these new regulations do not apply to Medicare. In order to maximize mental health care seniors, should look carefully at their supplemental policies.

To better help seniors navigate their options, we are reposting excerpts from several relevant posts from the Center for Medicare Advocacy, Inc. (CMA) and providing links to this valuable information.

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Final Parity Ruling and Obamacare

healthinsurance2Cause for celebration or just one victory in a long-term battle

On November 8, 2013 the Obama administration released the final rule providing guidance on how health insurance plans should implement mental health parity. In short, the rule states that mental health coverage must be equitable to how insurance plans cover other physical conditions. Restrictions accessing care and reimbursement for services can no longer be different for mental health in relation to other health care services. Additionally the ACA, more popularly known as Obamacare, requires that mental health coverage be included as an essential health benefit for plans available through the market exchange.  In short, as of January 1, 2014 private, marketplace exchange and Medicaid Expansion plans must offer mental health care and it must be with parity.

Much has been written about the ruling. Most of it positive. Bloomberg BNA states advocates are praising the rule. The National Council applauds the ruling saying it is “a huge victory for people living with mental health needs and for the nation as a whole.

CFYM has covered the topic in past blogs and has provided instructions on how to fight for your coverage rights by challenging an insurance claim denial. Carol McDaid of the Parity Implementation Coalition posted on September 19 that now is the time to become an informed, empowered, and vocal consumer. There is much work still to be done to ensure the civil rights and protection of people living with a mental health condition when it comes to access, however.

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Will Your New Insurance Plan Do a Better Job Covering Your Mental Health Care?

Gretchen is optimistic that hers will.

The federal government is in shutdown mode but the health insurance marketplaces are open for business. People with mood disorders and their families have the opportunity to explore the pros and cons of different insurance plans that become effective in January 2014. Mental health care must be covered, but will the different levels of plans pay for the services you need? What will you need to pay for yourself?

Gretchen, who lives with a mental health condition, is hopeful that her new insurance will cover her preferred therapist and psychiatrist...

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