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Government News
Eating Disorders Added in State Parity Expansions
Psychiatric News
Volume 43 Number 22 page 9-24

In a year when most states waited to see what version of federal mental health insurance parity legislation Congress would pass, a couple did decide to proceed with expanding their own parity laws.

Patients with autism, eating disorders, substance-abuse problems, or post-traumatic stress disorder received greater access to treatment under legislation passed by the Massachusetts legislature and signed into law in August.

The measure (H 4423) added the four conditions to the list of biologically based illnesses exempt from treatment limitations. Thus, health insurers are no longer allowed to limit treatment of those conditions to 24 outpatient sessions and 60 days of hospitalization each year.

"There is a broad and general agreement among psychiatrists that full parity is needed in the state," said Eugene Fierman, M.D., former president of the Massachusetts Psychiatric Society (MPS), which lobbied for the legislation.

The conditions that faced the strongest opposition from the state's insurance industry for equal coverage, Fierman told Psychiatric News, were eating disorders.

The National Eating Disorders Association (NEDA) estimates that 5 million to 10 million Americans suffer from eating disorders. Anorexia nervosa, specifically, has the highest premature mortality rate of any psychiatric disorder, according to the NEDA.

The association reports that insurance coverage for eating disorders is extremely insufficient nationwide, in part due to the high cost of care. The average annual overall cost for treating a person with anorexia nervosa is $6,054, according to the NEDA.

"We've all seen [insurance] limitations in eating-disorder cases," said Fierman, chair of the MPS Legislative Committee." People with anorexia can die, so it shouldn't matter if they have used up their allotted days of covered outpatient care."

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Another important provision of the new measure jettisoned a provision of the 2000 state parity law that allowed existing mental disorders to be added to the parity law only if the commissioner of insurance and the commissioner of mental health both agreed to the change. The law now allows the commissioner of mental health alone to decide whether to put additional conditions under parity coverage, according to Lisa Simonetti, MPS's lobbyist.

"That last provision was quite important for us," Simonetti told Psychiatric News.

Eating disorder advocates had pushed for years for both commissioners to agree to add those conditions to the parity law without success.

Massachusetts parity supporters had pushed for passage of a more generous earlier version of the measure that would have given the state mental health commissioner the authority to require unlimited coverage for any disorder contained in APA's Diagnostic and Statistical Manual of Mental Disorders. The original House bill also would have allowed adding any treatments deemed medically necessary by a physician.

That more comprehensive version passed the House but was replaced by less inclusive language in the Senate. The law containing the Senate language went into effect November 5.

Future lobbying campaigns about parity expansion, Fierman said, will focus on the use of a "functional limitation" standard rather than one based purely on diagnosis.

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Supporters of parity coverage for eating disorders in Illinois thought they had finished the legislative battle for a similar parity expansion there only to have it dragged out. The bill aimed to add two eating disorders to the mental illnesses that health insurers are required to cover (Psychiatric News, July 4).

The measure (HB 1432) was to amend the state's parity requirement to include anorexia nervosa and bulimia nervosa as "serious mental illness[es]" that insurers are required to cover at parity with other medical benefits.

The bill initially stalled in the legislature over opposition from health insurers, but it passed in May when its protections were limited to the two specific eating disorders. The original legislation sought to include the diagnosis of eating disorders not otherwise specified, which insurers opposed as too general.

The legislation hit another roadblock when it was sent to Gov. Rod Blagojevich (D). He sought to add language to expand coverage to include" adjustment disorders" resulting from sexual assaults and domestic violence at the urging of the Illinois Center for Violence Prevention (ICVP), according to Meryl Camin Sosa, executive director of the Illinois Psychiatric Society (IPS). He used a tool available in only seven states—the amendatory veto—to insert the additional language. The governor's tactic meant the bill with his amendment went back to the legislature, which opposed the addition.

Legislators balked at the addition because they saw it as a violation of the General Assembly's rules, which require that amendments made by the governor be related to the language already included in the bill. The new language was seen as largely unrelated.

"To IPS it was unfair to support such an effort by the ICVP, which essentially circumvents the legislative vetting process (hearings, testimony, etc.) after IPS had to go through the entire two-year process to get the bill passed," Sosa told Psychiatric News.

The Illinois House came back into a special veto session and overrode the governor's amendatory veto. The Senate overrode the veto on September 22.

The law was effective immediately after the veto was overridden.

"This bill is a major step forward in eliminating discriminatory barriers that limit access to health care for those suffering from an eating disorder," said Kimberly Dennis, M.D., medical director of Timberline Knolls, a Chicago treatment facility for eating disorders.

Though approving the parity measure to expand access to mental health care, Illinois legislators failed to pass a bill (AB 1900) that would have required group and individual insurance policies to provide up to $36,000 of coverage for a wide range of services and providers to treat children with autism spectrum disorders.

The text of the Massachusetts bill is posted at<www.mass.gov/legis/bills/senate/185/st02/st02840.htm>. Information on the Illinois measure is posted at<www.ilga.gov/legislation/BillStatus.asp?DocNum=1432&GAID=9&DocTypeID=HB&LegId=30223&SessionID=51&GA=95>.

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