Department of Health & Human Services issues Final Rule to language of Mental Health bill, providing access to life-saving treatment.
Kantor & Kantor Applauds the Department of Health and Human Services for Issuing the Final Rule for Mental Health Parity and Addiction Equality
NORTHRIDGE, Calif., Nov. 21, 2013 /PRNewswire On November 8, 2013, after five years of deliberation, the Department of Health and Human Services (HHS) issued the Final Rule for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equality Act (MHPAE) of 2008. The Final Rule details how insurers must cover care for mental health and addiction treatment.
Kantor & Kantor LLP congratulates the Eating Disorders Coalition (EDC) and the Residential Eating Disorders Consortium (REDC) for their instrumental roles in fighting to ensure that the Final Rule provided the fullest protection for patients with eating disorders. Founding partner Lisa Kantor is honored to be a member of the board of the EDC and the advisory board of the REDC. Through avenues such as lobbying and public education campaigns, the EDC and REDC tirelessly strived to provide the protection that those suffering with mental health conditions or addiction deserve. These organizations faced an uphill battle in their efforts to establish parity for those suffering with mental illness and addiction. Parity ensures appropriate treatment is covered by health insurance policies.
Although MHPAE was passed over five years ago, the bill has lacked the clarity and guidelines necessary to hold insurers accountable for mental health and addiction coverage. The Final Rule removes ambiguity from the language of the bill in five significant ways. In the change most substantial for our clients, the Final Rule defines intermediate services such that it requires that medical/surgical care and behavioral health services be handled in a comparable fashion. While the Final Rule does not specifically require that residential services be covered, it does say that if insurers offer "post acute care services" for medical services, then they must also offer coverage for residential treatment and other intermediate services for behavioral health.
"The Final Rule clarifies the intent of the MHPEA," said Kantor. "Not only does this confirm the way insurers must interpret the law, but it lays the foundation for true parity for those seeking treatment for mental illness and addiction. I am confident that the Final Rule for this law will remove significant barriers to those seeking mental health and addiction treatment. Furthermore, this will provide my clients - most of whom suffer with eating disorders - access to life-saving treatment."
Other significant changes include eliminating the term "clinically appropriate exception" from the Non Quantitative Treatment Limits (NQTL) portion of the regulations. This means that plans will no longer be able to require a patient to go to a facility in their own state if the plan allows plan members to go out of state for other medical services. The Final Rule now recognizes Multi-Tier plans and multiple provider networks, so long as they are not more restrictive than similar plans providing coverage for non-mental health or addiction coverage. Under the Final Rule, Managed Care Organizations (MCOs)/Insurance Plans must disclose medical necessity definitions and the process used to construct NQTLs. Finally, the Final Rule provides a formula for how plans and insurers can deal with cost exemptions if the changes necessary to comply with the law raise costs by at least 2% in the first year.
For more on MHPAE and the fight to eliminate mental health parity violations, see http://eatingdisorderscoalition.blogspot.com/2013/11/edc-succeeds-in-parity-push.html.
About Kantor & Kantor, LLP
Kantor & Kantor is the largest law firm in the country exclusively representing plaintiffs who have been denied insurance benefits from life, health, disability, and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters and files more ERISA cases than any other law firm in California. For more information, log on towww.kantorlaw.net, call (800) 446-7529, or follow the firm at http://www.kantorlaw.net/Eating_Disorder_Blog.aspx.
For Immediate Release
The Lotus Collaborative Celebrates 2 Years in Santa Cruz
Santa Cruz Community invited to Annual Sparkle Party Celebration
SANTA CRUZ, California, December 16, 2013 -- The Lotus Collaborative is approaching their 2nd year serving Santa Cruz and surrounding counties with their specialized treatment in eating disorder recovery. They hold an annual Sparkle Party Celebration and are inviting the community of Santa Cruz to join them on January 9, 2014 from 5-9pm. At 5pm, the Santa Cruz Chamber of Commerce will commence an official ribbon cutting ceremony to honor their 2-year anniversary. As a community connector, and a new member of Think Local First Santa Cruz, the Lotus Collaborative will be honoring local natural healers through self-care stations for guests to enjoy mini massage therapy sessions, polarity therapy, Breema bodywork, bio-feedback, naturopathic medicine, angel card readings and more. DJ Sparkle, also local, will musically entertain guests inside a heated tent, featuring an impressive lighting display by Om Gallery of Santa Cruz. Tours of the treatment center will occur for the duration of the event, in addition to snacks, a sparkle photo booth, & networking.
The Lotus Collaborative also invites the community to attend their weekly Eating Disorder Recovery Support group every Sunday from 1-2:30pm. Meet other people working towards recovery from their eating disorder in a safe environment with the opportunity to build relationships and practice recovery skills or recovery coaching skills. Lunchtime meal support is available at 12 Noon. Free and open to the community.
Running parallel to the Recovery Support group, also weekly on Sundays from 1-2:30pm, is their Family & Supporters Recovery group. This free community support group is designed to provide parents, partners, siblings, roommates or other family members in the community with time devoted just to them; to recognize common struggles and learn new ways to cope. RSVP for both groups via firstname.lastname@example.org
About The Lotus Collaborative
The Lotus Collaborative is a health & recovery center specializing in eating disorder treatment, health, weight, exercise, and nutrition concerns. In addition to providing day treatment, individual, group and family therapy, TLC provides education, nutritional counseling, life skills training, mindfulness & free community support. Visit http://www.TheLotusCollaborative.com
Tracy Korpela, Community Relations & Marketing Coordinator
The Lotus Collaborative, 831.818.1602 cell
"I must learn to love the fool in me - the one who feels too much, talks too much, takes too many chances, wins sometimes and loses often, lacks self-control, loves and hates, hurts and gets hurt, promises and breaks promises, laughs and cries. It alone protects me against that utterly self-controlled, masterful tyrant whom I also harbor and who would rob me of human aliveness, humility, and dignity but for my fool." - Theodore I. Ruben, MD
This is one of my favorite quotes in the whole world. It's hung on the wall above my desk and I read it whenever my inner-critic gets too loud. It reminds me of who I am, where I've come from, what I'm on this earth to do and why it's so important to live authentically. I have been staring at this quote for the past few minutes, ruminating on my journey towards self-acceptance and all of the women that I know who struggle so much with this. So many women place more value on the "masterful tyrant" than on the glorious mess that makes us human. I have certainly spent a large portion of my life living within this paradigm. And we place our value there for good reason: most of us have been told from an early age that the ideal woman is anything but messy. She is in fact the opposite: self-contained, rational, put-together, not too much of anything, but enough of everything. Many of us spend every waking moment trying to be more like this ideal and less like the imperfect, sentient beings that we are. But this comes at a great cost. As we deny ourselves our most authentic nature, our deepest and most dynamic parts, we begin to "rob" ourselves of "human aliveness"as this quote so eloquently suggests. We become depressed, aimless, or driven and disconnected. We have to move faster and do more in order to avoid the growing feeling of emptiness and fit into the expectations of a male dominated world. And for what? Ultimately, for love I think. Love and acceptance. Isn't that what we're all striving for? But the longer we deny ourselves and the world our authentic nature - whatever unique form that may take, the further from love and acceptance we get. In my experience, it's near impossible to love or be loved from an inauthentic place - it just leads back to more emptiness. So my hope for all of us, women and men alike is that we begin to recognize this value system based on denial of the essential self; That we challenge the belief that to be loved means to extricate the most alive parts of us and that we embrace the "fool" who knows that the messy-ness in each of us is the most spectacular part of being human.
Here at Lotus, we celebrate the belief that we are more than our bodies, faces and features, but as this video demonstrates, learning to recognize and embrace our external beauty can be a step towards freeing all parts of ourselves.
-Lauren Reppy, MFTi 74501