December 22, 2012

Psst! Pass it on! Action Alert from EDC


Action Alert from the Eating Disorders Coalition:

We have until December 26 at 5 pm (EST)!

Support EDC’s efforts to strengthen the affordable care act!

The design of the Essential Health Benefits (EHB) is an important opportunity to address the health needs of more than 14 million Americans suffering from eating disorders. With the passage of the Affordable Care Act there was the inclusion of mental health as a specific benefit that must be covered. The EDC is working hard to make sure eating disorders are incorporated into the EHB. This is an opportunity to lessen the continued and widespread insurance discrimination experienced by people with eating disorders.

We need your voice!

The EDC asks you to support our extensive comments by sending in your comments as well.

Here is how:

1. go to: http://www.regulations.gov/#!submitComment;D=CMS-2012-0142-0001
2. Click "Comment Now" button

3. Enter your name and other information

4. Cut and paste below (limited to 2000 characters)
5. Click Submit

Comments: (Note: These are so short and concise due to the 2000 character limitation)

Please incorporate the following recommendations so that people with eating disorders will have better access to treatment.

1. Benefit substitutions should not be a vehicle to exclude or limit needed care for eating disorders.

The proposed rule allows plans substantial flexibility to substitute benefits within the EHB categories. This approach could undermine coverage for enrollees with eating disorders if a plan is able to use its substitution flexibility to exclude eating disorders treatment or eliminate medically necessary components of the continuum of care for these conditions. All States should have robust and detailed EHB packages that ensure full coverage of all medically necessary services across the continuum of care in each of the categories, including the mental health category.

2. Ensure that health insurance plans do not discriminate on the basis of sex in the implementation of the essential health benefits.

According to Section 1557, limits on covered services and condition-based exclusions that disproportionately affect women can be discriminatory. Plans that cover treatment for mental health conditions, but exclude it for eating disorders, including residential care, discriminates against women given that three times as many women as men suffer from these conditions. The Secretary must address this sex discrimination and ensure eating disorders treatment is included in the EHB package.

3. Make out-of-network more affordable

Requirements related to cost-sharing in the proposed rule may expose individuals to high out-of-pocket costs. Since there are not many providers with eating disorders expertise many individuals with eating disorders require access to medical providers and eating disorder specialists, who are not within the plan’s specified network. The Department should create a special rule to ensure out-of-network providers are a viable option for patients that are unable to get the care they need through in-network providers.

Eating Disorders Coalition
www.eatingdisorderscoalition.org

No comments:

Post a Comment