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Testimony on H.B. 1174 An Act Requiring Mental Health Parity For Disability Policies

House Bill 1174

An Act Requiring Mental Health Parity For Disability Policies

January 24, 2012

Testimony of Laurie Martinelli, Executive Director

National Alliance on Mental Illness of Massachusetts (NAMI Massachusetts)

Honorable Chairs and Members of the Committee:

My name is Laurie Martinelli, and I am the Executive Director of the National Alliance on Mental Illness of Massachusetts (NAMI Massachusetts).

NAMI is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services and treatment, and is steadfast in its commitment to raising awareness for all of those in need. Since our inception in 1979, NAMI has been dedicated to improving the quality of life of individuals and families affected by mental illness.

We are here today to advocate for a health care system that ensures equal access to treatment for those with mental illness, and specifically I am here today in support of House Bill 1174, an act which would require parity for both mental health and physical health in disability insurance.

Today, we have a system where physical health coverage is not equal to mental health coverage in disability insurance.  The disability insurance system that exists  covers physical disabilities for life, and only covers mental disabilities for two years. This difference is called discrimination and is patently unfair.

The Legislature has redressed this inequity in the Parity legislation that it passed in 2000 and again in 2009 – parity created fundamental fairness between mental illness and physical illness by requiring health insurance for “biologically based” illnesses.  NAMI is asking for this same equal coverage by disability policies for both mental and physical health.

Our state’s mental health care crisis is everyone’s problem and its solution is everyone’s responsibility.

Passing this H. 1174 would not require an outlay of any taxpayer money, a resource we know is in short supply these days.

It would require companies that provide short and long term disability insurance to cover physical disabilities and mental disabilities for the same length of time, and it would require these companies to not have any different limitations for behavioral health coverage than those than exist for physical health.

We know that there are costs involved in funding shelters, hospital emergency departments, and the criminal justice system – costs that are increased as programs for people with mental illness are decreased.  This bill would ensure that people with mental illness that are not able to work for a period of time would receive the coverage afforded by their disability policies. Otherwise, they are forced to access and rely upon state funded safety net services.

Many people who go on disability insurance can, with treatment and time, return to work and again be productive members of society. This bill would help ensure that the insurance coverage they have would cover some of the costs associated with their recovery from mental illness.

NAMI has brought both consumers (and peers) and experts here today to testify on the impact this has on the community, and also to discuss the underlying assumptions behind excluding mental health issues, that mental illness is not malingering or the idea that mental illness is not a real illness in the same way that diabetes is an illness.

NAMI urges the committee to issue a favorable report on House Bill 1174.

Thank you for the opportunity to testify.

KNOW YOUR DISCHARGE PLANNING RIGHTS FROM MASSACHUSETTS LICENSED PSYCHIATRIC UNITS!

KNOW YOUR DISCHARGE PLANNING RIGHTS FROM MASSACHUSETTS LICENSED PSYCHIATRIC UNITS!

Every patient of a locked psychiatric unit, regardless of coverage, has a right to effective and proper discharge planning.  Depending on insurance coverage, some patients may have additional discharge planning protections. Below please find a listing of your rights pertaining to hospital discharge planning.

FOR MASSHEALTH RECIPIENTS:

  • The discharge professional (or the person responsible for formulating discharge plan) should screen you within 24 hours of admission.
  • Facility staff should commence discharge planning and activities within 72 working hours of your admission.
  • If you require additional care and resources after discharge, a written plan must be developed.[1]

FOR MEDICARE RECIPIENTS:

  • Your discharge plan, developed by your provider, must be in writing![2]
  • Your plan must also be “individualized and comprehensive.” Therefore, your discharge plan must be particular to your condition with specific treatments and goals outlined.[3]

FOR THOSE PATIENTS WHO ARE PRIVATELY INSURED:

  • People who have private insurance are not always provided the same protections as recipients of Medicare or MassHealth. 
  • Protections afforded to patients regarding discharge planning differ from one insurance policy to another, but it is important to review your individual policy to understand all of your rights.

FOR ALL PATIENTS REGARDLESS OF INSURANCE COVERAGE:

  • The Massachusetts Department of Mental Health acknowledges that facilities should make every effort possible to avoid discharge to a shelter or onto the street.  However, in situations where patients with mental illness are being released onto the street, these discharge plans should include various recommendations and alternative resources for those patients.[4]
  • If you are 18 or older and without a legal guardian, you must give your informed consent, which involves providers informing you of the proposed course of treatment, all alternatives to that proposal, and the risks involved in accepting either the proposed course or the alternatives.  Likewise, you must provide consent to the proposed discharge plan.  In cases where a guardian had been appointed, the guardian must provide informed consent.
  • You have rights under the American Hospital Association’s Patients’ Bill of Rights:
    • “The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to other appropriate care and services that the hospital provides or transfer to another hospital. The hospital should notify patients of any policy that might affect patient choice within the institution.”[5]
    • You should be actively involved in formulating your discharge plan and should remain in discussion with your providers to be part of the planning process.
    • If you have a legal guardian, that person has a right to be involved in treatment and discharge planning.
    • If you are a minor (under age 18), a parent or other person with legal custody has the right to be involved in treatment and discharge planning.
    • If you are an adult (age 18 or over) and want a family member or other person to be involved in your treatment planning or discharge planning, you or your legal guardian must give consent to the facility for that person to be involved.
    • In situations where healthcare proxies are involved, it may state explicitly in the healthcare proxy document that the proxy can be involved in discharge planning.  However, even when the document does not explicitly state this, if the document states that the proxy can be involved in general healthcare decisions, discharge planning may still be considered part of the healthcare proxy’s authority.

WHAT TO DO IF A MEDICAL FACILITY HAS VIOLATED THESE RIGHTS:

  • If you think that your rights or those of your loved one have been violated, complaints can be made to the following entities:
    • Unit staff: Since locked psychiatric units are licensed by the Massachusetts Department of Mental Health, every psychiatric unit has to comply with the DMH complaint process which provides that complaints may be filed with unit staff.
    • Human Rights Officer: Every psychiatric unit must have a Human Rights Officer who also must accept complaints and who can assist patients in writing complaints.
    • Director of Compliance/Quality Assurance: Each facility will also have a director of compliance/quality assurance or the equivalent. NAMI Massachusetts can help you find out who this person is.  You can complain to this person as well.  
    • If a Medicare recipient OR a MassHealth recipient, you can send a letter complaint to:

Complaint Unit
Division of Health Care Quality
99 Chauncy Street, 11th Floor
Boston, MA 02111

Fax:   617-753-8165

File your complaints in writing if possible. Keep a copy of your complaint for yourself. Keep also the name of the staff you filed the complaint with and the date you filed it.

Other individuals, such as family members, may file any of these types of complaints on your behalf.

IF YOU PREFER, YOU CAN ALWAYS CONTACT NAMI MASSACHUSETTS AND WE WILL HELP YOU WRITE AND SEND THE APPROPRIATE COMPLAINT LETTERS.

NAMI Massachusetts

400 West Cummings Park, Suite 6650

Woburn, MA 01801

(781) 938-4048

Know Your Discharge Planning Rights from Mass. Licensed Psychiatric Units-1.2012 (PDF)

1/2012


[1] 130 C.M.R. 415.419(B)(3)

[2] 42 C.F.R. § 412.27(d)

[3] 42 C.F.R. § 412.27(d)

[4] Department of Mental Health Discharge Procedures read:  “A facility shall make every effort to avoid discharge to a shelter or the street. The facility shall take steps to identify and offer alternative options by a patient, document such measures, including the competent refusal of alternative options by a patient in the medical record.  In the case of such discharge, the facility shall nonetheless arrange for or, in the case of a competent refusal, identify post-discharge support and clinical services.  The facility shall keep a record of all discharges to a shelter or the street in a form approved by the Department and submit such information to the Department on a quarterly basis.”  (104 C.M.R. § 27:09(1) (b))

[5] AHA Bill of Rights, http://www.patienttalk.info/AHA-Patient_Bill_of_Rights.htm

NAMI Massachusetts’s comments on State Demonstration Project to Integrate Medicare and Medicaid Services

MassHealth has been working for over one year to develop a Demonstration Project that it will send to the federal government (Centers for Medicare and Medicaid Services) on a proposal to integrate Medicaid and Medicare for the 110,000 people who are called “dually eligible” because they have MassHealth and Medicare.  Two out of three people who are “dually eligible” in the state have a mental health diagnosis so this is a BIG issue for NAMI Massachusetts.

This Demonstration Project came about because of President’s Obama Health Reform Law (the Affordable Care Act of 2009) and his efforts to achieve cost savings in both Medicare and Medicaid programs by having a major realignment in how health care is delivered to the “dually eligible.”  Massachusetts was one of 15 states chosen by the feds to receive a grant that allowed MassHealth to develop this Demonstration Project.

NAMI Massassachusetts has been following this effort for over year and final comments on the proposal are due today, Jan. 10th at 5pm.    Massachusetts is encouraged to combine MassHealth and Medicare into contracts administered by a Third Party, known as Integrated Care Organizations (ICO).  MassHealth will take the comments it receives and use them to finalize its proposal to the federal government (Center for Medicare and Medicaid).

While NAMI Massachusetts thinks the proposal to integrate Medicare and Masshealth is generally a good idea and will improve care for people with mental illness, we have many concerns about the Demonstration Project that the State recently unveiled.

Please read a copy of NAMI Massachusetts’s comments as this is a huge issue for many people with mental illness.