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Parity: New Mental and Behavioral Health Mandates and Your Options

Parity: New Mental and Behavioral Health Mandates and Your Options. Presented by: Steve Wagner – Health Services Consultant, Aurora EAP Pauline Krutilla – Regional Manager, Aurora EAP . Mental Health Parity and Addiction Equity Act of 2008. What is it?

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Parity: New Mental and Behavioral Health Mandates and Your Options

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  1. Parity: New Mental and Behavioral Health Mandates and Your Options Presented by: Steve Wagner – Health Services Consultant, Aurora EAP Pauline Krutilla – Regional Manager, Aurora EAP

  2. Mental Health Parity and Addiction Equity Act of 2008 • What is it? • The new law is an extension of the Mental Health Parity Act of 1996 (MHPA) • First legislation ever to provide parity between mental health benefits and medical/surgical benefits • Required group health plans with annual dollar limits or aggregate lifetime for medical/surgical benefits to apply those same dollar limits for mental health benefits

  3. Mental Health Parity and Addiction Equity Act of 2008 • The Result: • Didn’t achieve full parity • Reasonable first try, but improvements were still needed • Revamped in 2008: Companies will need to act fast to meet compliance deadlines!

  4. Mental Health Parity and Addiction Equity Act of 2008 Effective Dates: The parity provisions will not apply to plan years beginning before the LATER of: the date on which the last of the collective bargaining agreements relating to the plan terminates or January 1, 2010

  5. Mental Health Parity and Addiction Equity Act of 2008 • What’s Different? • If a group health plan covers both medical/surgical AND mental health benefits, the financial requirements and treatment limitations for mental health must be NO MORE RESTRICTIVE than those requirements and limitations that apply to your medical/surgical benefit

  6. Mental Health Parity and Addiction Equity Act of 2008 • This means… • Co-payments • Medical/Surgical = Mental/Behavioral • Deductibles • Medical/Surgical = Mental/Behavioral • Number of Visits Allowed • Medical/Surgical = Mental/Behavioral • Days of Coverage • Medical/Surgical = Mental/Behavioral

  7. Mental Health Parity and Addiction Equity Act of 2008 • This means… • Out-of-Network Coverage • Medical/Surgical = Mental/Behavioral • Cost-Sharing • Medical/Surgical = Mental/Behavioral

  8. Mental Health Parity and Addiction Equity Act of 2008 Plus… Standards for determining medical necessity and reasons for denial of any mental health or substance abuse-related benefits MUST be made available upon the plan participants’ request

  9. Mental Health Parity and Addiction Equity Act of 2008 Why the Change? The MHPA of 1996 ONLY recognized to mental health benefit coverage (I.E. no substance abuse treatment benefit) and parity ONLY applied to dollar limits placed on mental health coverage So What?

  10. Mental Health Parity and Addiction Equity Act of 2008 • Here’s What • The old laws were easy to get around • 87% of surveyed companies had LOWER mental health benefits for their employees • 44% had NO out of pocket limit for addiction treatment • Overall cost-sharing for mental health benefits was significantly higher

  11. Mental Health Parity and Addiction Equity Act of 2008 Now What? What does this mean for my premiums? ? Does this mean all or nothing for mental health? ? I can’t afford to pay MORE! ? Is there any way around this?

  12. Mental Health Parity and Addiction Equity Act of 2008 • There ARE exceptions to these new rules… • The new laws do NOT apply to: • Medicare recipients • Patients with individual health insurance policies

  13. Mental Health Parity and Addiction Equity Act of 2008 • There ARE exceptions to these new rules… • Your company may be exempt from these mandates if: • Your average annual company size is 50 employees or less • You experience a 2% or greater cost increase your first year as a result of the new law (or a 1% increase in subsequent years)

  14. Mental Health Parity and Addiction Equity Act of 2008 What about those who are NOT exempt? It’s ALL or NOTHING!

  15. Mental Health Statistics & Your Benefit Options • Why is mental health parity so important? • Two important factors to consider: • Mind-Body Connection • Economic cost of mental & behavioral disorders among employees in the workplace

  16. Mind-Body Connection Psychologically distressed patients utilize health care at a rate of 2 to 3 times higher than non-distressed patients. Source: Kaiser How can that be?

  17. Mind-Body Connection 90% of the 10 most common complaints in primary care have NO ORGANIC BASIS! Kaiser performed a ten-year follow-up study & found no organic conditions emerged to explain the somatized complaints.

  18. Mind-Body Connection • Among these complaints are: • Tension Headaches • IBS • Chronic Fatigue Syndrome • Muscle Pain • Immune System Disorders • Upset Stomach

  19. Mind-Body Connection • Although most psychosomatic illnesses respond to drugs, painkillers and other medical treatments, the symptoms will often return until the mental or emotional root is addressed. • Depression first manifests as pain in 80% of cases • Many primary care providers spend numerous office visits treating patients looking for pain relief! • Milliman – May 2009

  20. Mind-Body Connection • Stress: The Silent Killer • A recent 20-year study concluded that UNMAGANGED STRESS was a more dangerous risk factor for cancer and heart disease than either cigarette smoking or a high-fat diet.

  21. Mind-Body Connection • Exactly how prevalent is this phenomenon? • Diagnosable behavioral disorders are prevalent in about 1 in every 4 Americans in a given year. • Nearly half of all Americans will meet the criteria for a diagnosable behavioral disorder in their lifetime. • Milliman – May, 2009

  22. Economic Cost The problem employee costs the typical American company an average of 25% of his or her salary per year. EAPA

  23. Economic Cost Up to 68% of all workers will, at some time, experience workplace problems severe enough to prevent them from coping with day-to-day duties. EAPA, SHRM Have YOU ever taken a “mental health day”?

  24. Economic Cost Every year DEPRESSION costs US businesses… • $51.54 billion in workplace costs • $36.25 billion for absenteeism • $15.30 billion for reduced productivity • $5.45 billion in loss of earnings due to depression induced suicides • EAPA • For a grand total of: • $56,990,000,000.00 • Journal of Clinical Psychiatry 2003; 64:1465-1475

  25. Economic Cost • Stress and substance abuse comprise more than 25% of employer health costs. • Stress is said to be responsible for MORE THAN HALF of the 55 million workdays lost annually because of absenteeism • Employees with DRUG AND ALCOHOL problems cost U.S. corporations an estimated $120 billion per year in lost productivity 70% of drug users are employed. US Department of Labor

  26. Economic Cost Employees experiencing conflict between work and family demands are 3 times more likely to consider quitting their jobs. Work Family Institute Replacing an employee costs a company an additional one-third to one-half of the employee's annual salary (U.S. Department of Labor).

  27. Mental Health Strategies Long Story Short… THE NEED IS REAL!

  28. Mental Health Strategies • Some things to consider when evaluating YOUR need for mental health insurance for your employees: • Absentee / Presenteeism • Medical insurance usage / premiums (consider ER visits, prescription drug history, spikes in utilization, etc…) • Employee retention and turnover • Company drug & alcohol policy

  29. Mental Health Strategies • If you decide to pursue full mental & behavioral health coverage for your employees, consider Behavioral Health Management options: • Can be offered through your insurance provider or a third-party company • Manages & monitors the level of care your employees receive • Helps ensure that treatments are effective and appropriate • Effective cost containment tool

  30. Mental Health Strategies Consider Employee Assistance Programs Employee assistance programs (EAP) can provide relief to those in of need help AND it’s an ALTERNATIVE to billable mental health treatment For every dollar invested in EAP, employers save from $5.00 - $16.00. Department of Labor

  31. Mental Health Strategies Educate your staff Teach your employees to become resilient • stress management techniques • relaxation / meditation • Healthy lifestyle coaching Offer educational programs & resources that teach PREVENTATIVE care

  32. Mental Health Strategies Questions? Like Further Info? Contact us at 1-800-511-4804 Or WWW.aurora.org/eap

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