Legislation Update

2007-2008 Parity Legislation   Currently, most states do not require health insurance policies to provide the same level of coverage for substance abuse treatment as is offered for medical or surgical treatment.  These bills would provide equitable access to substance abuse treatment for 23 million adults and children in need.  Untreated addiction currently costs American taxpayers $400 billion a year. This legislation could change that. The following bills have been introduced for this Congressional session: H.R. 1424, Paul Wellstone Mental Health and Addiction Equity Act of 2007.  Sponsored by Reps. Kennedy (D-RI) and Ramstad (R-MN); does not mandate coverage but requires parity for plans that already provide mental health benefits, all conditions in the DSM-IV are included, allows plans to use their own medical management criteria but requires full disclosure, does not preempt state laws, exempts companies with fewer than 50 employees and companies whose premiums increase by +2% after enactment of the law.  Effective January 1, 2008.  Recent Congressional Action: The House of Representatives passed H.R. 1424 on March 5, 2008.     S. 558, Mental Health Parity Act.  Sponsored by Senators Ted Kennedy (D-MA) and Paul Domenici (R-NM); does not mandate coverage but requires parity for plans that already provide mental health benefits, plans decide what conditions to cover, allows plans unfettered medical management, does not require disclosure of medical necessity criteria, exempts companies with fewer than 50 employees and companies whose premiums increase by +2% after enactment of the law.  Effective January 1, 2009.  Recent Congressional Action: Senate passed the Mental Health Parity Act of 2007 on September 18, 2007. H.R. 1663, Medicare Mental Health Modernization Act of 2007.  Sponsored by Rep. Pete Stark (D-CA); eliminates lifetime limits on inpatient mental health services, parity for outpatient mental health services, covers intensive residential and intensive outpatients services.  Effective January 1, 2008. H.R. 1571, Seniors Access to Mental Health Act.  Sponsored by Reps. Tim Murphy (D-PA) and Grace Napolitano (D-CA); gradually reduces copayment rates (from 50 to 20% by 2013) for outpatient psychiatric services under Medicare. Other Bills of Interest  ASAM supports many other addiction-related federal (and state) policies.  Below are a few that we are advocating for this year: H.R. 6331, Medicare Improvement for Patients and Providers Act.  Sponsored by Reps. Charles Rangel and John Dingell; averts pending 10.6% Medicare physician payment rate, updates payment rate to 1.1%, brings current 50% coinsurance rate for outpatient mental health services into parity with other outpatient medical services.  Status: Senate passed HR 6331 on July 9, 2008, by a veto-proof majority vote of 69-30.  The House overwhelmingly passed this bill on June 24, 2008.  H.R. 1108, Family Smoking and Rpevention Tobacco Control Act.  Sponsored by Rep. Henry Waxman; amends the Federal Food, Drug, and Cosmetic Act to provide for the regulation of tobacco products by the Secretary of Health and Human Services through the Food and Drug Administration, including through disclosure, annual regisration, inspection, recordkeeping, and user fee requirements.  (See also, S. 625)  Status: The House Energy and Commerce passed HR 1108 on April 2, 2008.  The Senate version of this bill, S 625 was passed out of its committee, the Senate Health, Energy, Labor and Pensions Committee, on August 1, 2007.   H.R. 460, Crack-Cocaine Equitable Sentencing Act of 2007.  Sponsored by Rep. Charles Rangel; amends the Controlled Substances Act and the Controlled Substance Import and Export Act to eliminate specified mandatory minimum penalties relating to the trafficking in, and possession, importation, or distribution of, crack cocaine.  H.R. 1593, Second Chance Act.  Sponsored by Rep. Danny Davis; seeks to help states and localities better address the needs of individuals reentering the community from the criminal justice system.  The centerpiece of the Second Chance Act is the reauthorization of a Department of Justice grant program for people returning to the community from incarceration.  (See also S. 1060)  Status: President Bush signed HR 1593 into law on April 9, 2008. H.R. 1348, NIDA and NIAAA Name Redesignation Act.  Sponsored by Rep. Patrick Kennedy; redesignates the National Institute on drug Abuse as the national Institute on Diseases of Addiction, and the National Institute  on Alcohol Abuse and Alcoholism as the National Institute on Alcohol Disorders ad Health.  (See also S. 1011) H.R. 5554, Justin Bailey Veterans Substance Use Disorders Prevention and Treatment Act of 2008.  Sponsored by Rep. Michael Michaud; requires that the every Department of Veterans Affairs (VA) medical center provides ready access to a full continuum of care for substance use disorders for veterans in need of such care, including screening, detox and stabilization, intensive outpatient care, relapse prevention, outpatient counseling, residential treatment, certain pharmacological treatments, coordination with groups providing peer-to-peer counseling, short-term, early interventions, and marital and family counseling.  (See also S. 2162)  Status: Passed in the House of Representatives on May 20, 2008.  Referred to Senate Committee on Veterans' Affairs. Note: Much of the above summary information was retrieved from Thomas, the legislative website of the Library of Congress.  [Thomas/Library of Congress Website] You can be a part of making this legislation a reality.  Contact your Congressperson and ask for his/her support.  Go to www.house.gov and www.senate.gov to find contact information for your Congresspersons.      Controlled Substances Act The ONDCP Reauthorization Act of 2006, signed into law on Friday, December 29, 2006, contained a provision that increases the prescribing limit for buprenorphine from 30 to 100 patients per waivered physician.   Physicians should note the following parameters, as specified in the legislation: physicians who have had their waiver for no less than one year must notify the Secretary of the Department of Health and Human Services of their need and intent to treat up to 100 patients.  [Waivers and registering with the DEA]    Alcohol Exclusion Laws  38 states either have alcohol exclusion laws in practice or "allow" for alcohol exclusion policies by not explicitly prohibiting them.  Since 2001, fourteen states (and the District of Columbia) have amended or repealed these laws (Colorado, Connecticut, District of Columbia*, Illinois*, Indiana*, Iowa, Maine, Maryland, Nevada, North Carolina, Oregon*, Rhode Island, South Dakota, Tennessee* and Washington). *In 2007.  Information retrieved from www.ensuringsolutions.org, Updated June 27, 2008. Update! New York's state assembly and senate have passed a bill that repeals it current alcohol exclusion insurance policy (June 19, 2008). This bill has not yet been signed by the governor. If your state is currently debating its alcohol exclusion law (a.k.a., UPPL), please notify ASAM. If you are interested in advocating for the repeal or denial of alcohol exclusion laws in your state, visit www.ensuringsolutions.org to access their Alcohol Exclusion Laws Toolkit.      State Parity Laws  Connecticut, Maryland, Minnesota, and Vermont have full parity laws for private insurance plans for both mental health and substance abuse benefits.  Oregon passed a full parity bill in 2005 but it will not take effect until 2007.  Indiana, Kentucky, Maine, and Rhode Island have parity for substance abuse but some limitations or exemptions apply.  New Mexico does not have parity for substance abuse but is considered to have "good" parity laws for mental health coverage. Arizona, Arkansas, California, Colorado, Delaware, Hawaii, Illinois, Louisiana, Massachusetts, Missouri, Montana, Nebraska, Nevada, New Jersey, and North Carolina all have limited parity laws (limited typically certain eligible groups).  Not all of these states offer parity for substance abuse if they offer it for mental health coverage. Alabama, Alaska, D.C., Florida, Georgia, Idaho, Iowa, Kansas, Michigan, Mississippi, New York, North Dakota, Ohio, Pennsylvania, Washington, Wisconsin, and Wyoming do not have parity laws although some have mental health mandates. Source: National Mental Health Association website. Recent State Parity Law Action Massachusetts:  The Massachusetts House of Representatives approves a mental health and addiction parity bill, H. 4423, on June 30, 2008.  The bill now goes to the Senate for consideration. Louisiana:  The Louisiana House Insurance Committee voted down the 2007 parity bill on June 13, 2007. North Carolina:  North Carolina's mental health parity legislation took effect on July 1, 2008.  It requires group health insurance offer coverage for 9 major mental health disorders (excluding addiction) that is on par with coverage offered for physical medical conditions.            New Jersey:  On December 4, 2006, New Jersey State Senate passed S. 807, a bill that provides for full parity in healthcare coverage, by a 29-9 vote.  This bill has not yet been approved by the full Assembly or by Governor Corzine.  Tennessee:  Due to the efforts of Dr. Richard Soper and the TNSAM, the Tennessee Medical Association House of Delegates has added a resolution to the 2007 legislative package urging the Comptroller to complete a review of the state's alcohol and substance abuse statutes and programs.  Dr. Soper used the Join Together's "Blueprint for the States" as a template for his presentation.