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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

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
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
mental health parity and addiction equity act of 20081
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!
mental health parity and addiction equity act of 20082
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

mental health parity and addiction equity act of 20083
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
mental health parity and addiction equity act of 20084
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
mental health parity and addiction equity act of 20085
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
mental health parity and addiction equity act of 20086
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

mental health parity and addiction equity act of 20087
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?

mental health parity and addiction equity act of 20088
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
mental health parity and addiction equity act of 20089
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?

mental health parity and addiction equity act of 200810
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
mental health parity and addiction equity act of 200811
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)
mental health parity and addiction equity act of 200812
Mental Health Parity and Addiction Equity Act of 2008

What about those who are NOT exempt?

It’s ALL or NOTHING!

mental health statistics your benefit options
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
mind body connection
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?

mind body connection1
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.

mind body connection2
Mind-Body Connection
  • Among these complaints are:
  • Tension Headaches
  • IBS
  • Chronic Fatigue Syndrome
  • Muscle Pain
  • Immune System Disorders
  • Upset Stomach
mind body connection3
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
mind body connection4
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.
mind body connection5
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
economic cost
Economic Cost

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

EAPA

economic cost1
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”?

economic cost2
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
economic cost3
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

economic cost4
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).

mental health strategies
Mental Health Strategies

Long Story Short…

THE NEED IS REAL!

mental health strategies1
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
mental health strategies2
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
mental health strategies3
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

mental health strategies4
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

mental health strategies5
Mental Health Strategies

Questions?

Like Further Info?

Contact us at 1-800-511-4804

Or

WWW.aurora.org/eap