Ruling may broaden insurance plans' coverage for mental illness

Judge says Blue Shield must cover woman's anorexia treatment at a residential facility. The Mental Health Parity Act requires insurers to provide equal coverage for severe mental illness and physical ailments.

The state Mental Health Parity Act obliges insurers to provide the same coverage for severe mental disorders as they do for physical ailments. (Mark Boster / Los Angeles Times)

By Carol J. Williams, Los Angeles Times  August 28, 2011

A Northern California woman's treatment for anorexia at a residential facility was medically necessary and must be covered by her healthcare plan, a federal appeals court has ruled in a case that could lead to more extensive benefits for those being treated for mental illnesses.

Jeanene Harlick's policy with Blue Shield of California specifically excluded coverage for residential care, the room and board expenses she incurred while at the Castlewood Treatment Center in Missouri for 10 months beginning in April 2006.

But the state Mental Health Parity Act obliges insurers to provide the same coverage for severe mental disorders as they do for physical ailments, a three-judge panel of the U.S. 9th Circuit Court of Appeals said Friday.

Harlick, 37, has struggled with anorexia for more than 20 years, the court noted. The judges said her doctors recommended the Missouri program when her body weight fell below 65% of ideal, a precarious condition that required insertion of a feeding tube within a month of her arrival at Castlewood.

Under the mental health parity law, insurance plans "must provide coverage of all 'medically necessary treatment' for nine enumerated 'severe mental illnesses,' " the court said, listing eating disorders as well as schizophrenia, schizoaffective disorder, bipolar disorder, major depression, obsessive-compulsive disorder, panic disorder, autism, and serious emotional disturbances in children and adolescents.

Steve Shivinsky, Blue Shield of California vice president for corporate communications, said the company was still reviewing the appeals court ruling and couldn't yet say what consequences it could have for Blue Shield or its 3.4 million policyholders in the state.

Harlick's attorney, Lisa Kantor of Northridge, said the ruling could have huge significance for those with eating disorders as well as emotional disturbances like Asperger syndrome and autism.

The ruling may not have immediate effect, though, because Blue Shield could petition the court for a full 11-judge rehearing of the case or ask the U.S. Supreme Court to review it.

carol.williams@latimes.com

http://www.latimes.com/health/la-me-mental-health-insurance-20110828,0,3394129.story

Health Reform's One-Year Anniversary

Today is the one-year anniversary of President Obama signing the Affordable Care Act into law, which when fully implemented, will cover 32 million Americans and begin to lower the rate of growth in health care spending. "The bill I'm signing will set in motion reforms that generations of Americans  have fought for , and marched for, and hungered to see," Obama said during last year's signing ceremony. "That our generation is able to succeed in passing this reform is a testament to the persistence -- and the character -- of the American people, who championed this cause; who mobilized; who organized; who believed that people who love this country can change it," he added. Health care advocacy groups around the nation  will host educational events in 33 states today to raise awareness about the law's benefits and the government's efforts in implementing the measure thus far.

IMPLEMENTATION SUCCESS:  As a result of the law, states received  $250 million in federal funding to strengthen their ability to review, revise, or reject unreasonable premium rate hikes. Nearly four million seniors who fell into the Medicare Part D doughnut hole received federal assistance that helped them purchase medications and 150,000 seniors have undergone a free wellness exam this year. The government recovered $4 billion in fraud last year and the law provides more funds to crack down on waste, fraud and abuse in Medicare and has been busily implementing new regulations that are designed to keep health insurers more accountable and increase access to coverage. As of this year, insurance companies can no longer discriminate against children with pre-existing conditions, drop coverage because of a simple mistake on an application, institute lifetime caps, limit choice of doctors, charge more for emergency services obtained out of network, or levy deductibles, co-payments or co-insurance for certain preventive benefits. More than a million young adults can stay on their parents' plans until their 26th birthday, and everyone will have the right to appeal insurer decisions to an independent third party. Similarly, four million small businesses have  access to $40 billion in tax credits and 12,400 Americans with pre-existing conditions are receiving coverage through temporary high-risk insurance pools that will provide coverage for sicker individuals until 2014. Americans can already compare available plan benefits, prices, and application denial rates at  HealthCare.gov. In 2011, the website will include pricing and comparison information  for small businesses.

LOOKING AHEAD:   Starting in 2014, individuals and families will have even more options through state-based health care exchanges that will allow Americans to select new regulated plans that will offer a comprehensive set of benefits. Under the law, if states fail to establish their own exchange, the federal government will build one for them -- something a surprisingly high number of conservative states  are willing to accept. States like Louisiana, Florida, Georgia and Alaska have refused to build their own unique marketplaces and have instead suggested that they would allow the federal government to step in. States that establish their own exchanges will be able to run their own markets (or partner if with other states), determine which insurance companies can offer coverage and dictate benefit rules. Americans below 133 percent of the federal poverty line (FPL) will be able to enroll in an expanded Medicaid program. In the coming year, the federal government  will issue more specific regulations about how much flexibility states will have to structure their health insurance exchanges and how generous those plans have to be. This year, restaurant chains and vending machines will be required to disclose nutritional content of food and Medicaid will stop reimbursing hospitals for conditions acquired during hospitalization.

REPUBLICANS PREDICTED THE WORST:   In the year since reform passed, Republicans in the House repealed the law (only to see the measure fall in the Senate) and are now attempting to defund reform. During the nearly 10-month legislative battle that preceded passage, the GOP characterized the bill as a "socialist" "government takeover" and warned Americans that the bill would destroy lives and American society, hurling apocalyptic warnings that seem downright satirical a year later. For instance, on the eve of passage now-House Speaker John Boehner (R-OH) said that passage of reform would result in "Armageddon" because the law will "ruin our country." Sen. Tom Coburn (R-OK) predicted "there will be  no insurance industry left in three years" and announced that seniors would "die soon," while Rep. Michele Bachmann (R-MN) stated that "no new health insurance policies can be written once this federal plan comes into effect." Fox News pundit Sean Hannity said, "If we get nationalized health care, it's over; this is socialism" and Glenn Beck predicted "the  end of prosperity in America forever...the end of America as you know it." Rep. Virginia Foxx (R-NC) suggested that seniors will be "put to death" by the government and Rep. Louie Gohmert (R-TX) lamented that a  similar fate faced American women. Potential presidential candidate and former Senator Rick Santorum (R-PA) warned that health reform "will destroy the country" because, "in the next year or so," America will have to "dramatically cut the military  because we can't pay for it."
From The Progress Report [progress@americanprogressaction.org]
Reposted at darkestcloset.blogspot.com