Report to the President on Mental Health and Substance Use Disorder Parity

By Cecilia Munoz

Federal Parity Task Force Takes Steps to Strengthen Insurance Coverage for Mental Health and Substance Use Disorders

From the national opioid epidemic to disturbing rates of suicide, we see the consequences every day of untreated mental health and substance use disorders.  Access to effective mental health and substance use disorder services can mean the difference between graduating from school and falling behind; between keeping a good job and becoming involved with the criminal justice system; between living a full life in recovery and dying by overdose or suicide. But if those services are needed, will your health insurance cover them in the same way it covers other medical treatment?

Six months ago, President Obama established a Federal Task Force to help make sure the answer is yes.

The Mental Health and Substance Use Disorder Parity Task Force was led by the Domestic Policy Council and consisted of the Departments of Labor, the Treasury, Defense, Justice, Health and Human Services, and Veterans Affairs, as well as the Office of Personnel Management and the Office of National Drug Control Policy. Our Task Force met with consumers, providers, employers, health plans, and State regulators, and read more than 1,100 public comments.

Today, we are presenting the President our final report, which includes a series of new actions and recommendations to ensure that insurance coverage for mental health and substance use disorder services is comparable to—or at parity with—general medical care.

Parity laws and regulations aim to eliminate restrictions on mental health and substance use disorder coverage – like annual visit limits, higher copayments, separate deductibles for mental health and substance use disorder services, and rules on how care is managed (such as pre-authorizations or medical necessity reviews) – if comparable restrictions are not placed on medical and surgical benefits.  Comprehensive insurance coverage that meets parity requirements can provide access to treatment and services, which in turn can reduce the difficulties faced by people with mental health and substance use disorders, help their loved ones, and increase their independence.

However, parity is only meaningful if health plans are implementing it well, consumers and providers understand how it works, and the government provides clear guidance and appropriate oversight.

During its tenure, Task Force agencies produced a user-friendly “Know Your Rights” brochure to increase knowledge about parity; released guidance outlining plans’ obligations for disclosing information to assess their compliance with parity; and issued a best practices report based on a series of interviews with State regulators on parity implementation and enforcement.

In conjunction with the final report, the Task Force announced an additional series of immediate action steps to advance parity.  Examples of these steps include:

  • $9.3 million to States to help implement parity protections.  Stakeholders told the Task Force that States need support and resources to ensure issuer compliance with parity.
  • A beta version of a new parity Web site to help consumers find the appropriate Federal or State agency to assist with their parity complaints, appeals, and other actions. The Task Force received many comments about the challenges consumers face in identifying the appropriate agency that regulates their insurance coverage.
  • A Consumer Guide to Disclosure Rights to help consumers and providers understand what type of information to ask for when inquiring about a plan’s compliance with parity. The Guide includes 11 scenarios, each with specific suggestions for information consumers have a right to that can help, as well as timing requirements for plans and issuers providing these documents.
  • Guidance on the application of parity to opioid use disorder treatment that responds to concerns raised by consumers about insurance barriers to timely treatment.

Examples of the longer-term recommendations included in the Task Force final report include:

  • Increase Federal agencies’ capacity to audit health plans for parity compliance.  Stakeholders have consistently called for enhancing audit capacity to improve oversight and enforcement of parity protections.  The Task Force concurred with this view and recommends increasing resources for this purpose.
  • Allow the Department of Labor to assess civil monetary penalties for parity violations.  Commenters called for stronger enforcement tools and the Task Force recommends providing the Department of Labor with this increased authority.
  • Work with the National Association of Insurance Commissioners and States to develop a standardized template that States could use to help assess parity compliance.  Commenters noted the challenge of State variation in approaches to parity oversight.
  • Ensure timely implementation of new Medicaid and TRICARE parity rules.

These and the other actions and recommendations in the Task Force report build on the ongoing work of the Administration to ensure that people with mental health and substance use disorders receive the care they need.

For example, the Affordable Care Act ended insurance company discrimination based on pre-existing conditions, including mental health and substance use disorders; required coverage of mental health and substance use disorder services in the individual and small group insurance markets; ensured that recommended preventive screenings, including for depression and alcohol misuse, are available with no co-pays; and, expanded Medicaid to millions of additional Americans, significantly improving coverage for mental health care and substance use disorder treatment.

The work of the Task Force provides a road map for moving forward so that our country will continue to make significant progress in expanding mental health and substance use disorder coverage for millions of Americans.

The final report is available here:


The Mental Health Parity Act (MHPA) is legislation signed into United States law on September 26, 1996 that requires annual or lifetime dollar limits on mental health benefits to be no lower than any such dollar limits for medical and surgical benefits offered by a group health plan or health insurance issuer offering coverage in connection with a group health plan.[1] It was largely superseded by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), which the 110th United States Congress passed as rider legislation on the Troubled Asset Relief Program (TARP), signed into law by President George W. Bush in October 2008. Prior to MHPA and similar legislation, insurers were not required to cover mental health care and so access to treatment was limited, underscoring the importance of the act.

New law prohibits discrimination based on genetic testing and family history

Genetic testing (i.e., identifying the risks of inheriting disease) has been widely heralded as a major breakthrough in disease prevention. Yet its adoption has been slowed by privacy issues. Polls have shown that Americans have been concerned about the possibility that employers and health insurers may use their personal genetic information to discriminate against them. Fortunately, a new federal law specifically outlaws this form of discrimination, thereby protecting patients and their families.

The age of genetic healthcare is here, and its benefits are now being realized. Genetic tests can allow for earlier detection of illnesses, often before symptoms have surfaced. A person who learns about his or her relatives’ medical histories can take steps to reduce the likelihood that he or she will develop disorders that run in the family. Genetic research holds the promise of better therapies to treat diseases and improvements to disease prevention strategies.


To encourage the use of genetic services, testing, and research, the Genetic Information Nondiscrimination Act (GINA) was passed by Congress and signed into law by President Bush in May, 2008. This law makes it illegal for health insurers and employers to discriminate against a person because of his or her genetic information. For the purposes of GINA, genetic information is defined as information about:

  • A person’s use of, or referral to, genetics services (including genetic counseling and testing)
  • The presence of a disease in a relative (up to and including fourth degree family members)
  • The genetic tests of a person’s relative participation of an individual or family member in research involving genetics

Specifically, GINA prohibits health insurers from denying coverage or charging higher premiums to individuals based on genetic information. A health insurer cannot request or require that an individual undergo a genetic test, or make any policyholder-related decision on the basis of the test.

Employers also cannot use genetic information to make decisions about hiring or firing an individual. Genetic information cannot be used to discriminate against an employee regarding job assignments or promotion. Employers cannot request or require a genetic test, nor can they purchase the genetic information of an individual or his or her family.

GINA is officially intended to protect individuals against the potential misuse of medical information, while encouraging the use of genetic tests and family history information in health care. However, the legislation will also benefit humanity by creating an environment in which more people will participate in medical research, contributing to potential medical advances.

For more information about GINA and genetics issues, please visit:

This information is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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Nurses identify 10 needs health startup should focus on

The following list was compiled from interviews with Sheila Antrum (president and senior vice-president, health adult services, UCSF Medical Center), Daphne Stannard (director and chief nurse researcher, Institute for Nursing Excellence, UCSF Medical Center), and Alberto Garcia (patient care director, health adult services,UCSF Medical Center).

Why are we sharing this? UCSF’s Center for Digital Health Innovation was formed three years ago to help improve patient care using technology, and we’d like to see more collaboration between health systems and entrepreneurs in health care. Please reach out to us if you’re working on any of these issues!

1. Patient and family navigation technology. Health systems employ many people as “navigators” to guide patients and their families from one location in a hospital or clinic to another. We like the idea of such technology that in addition to guiding patients through the hospital, helps patients and family members stay abreast of clinical updates. For example, for a patient getting surgery, the app would help guide the patient from the waiting area to the preoperative area and then would later alert the patient’s family members when the surgery has been completed. This solution relies on deep integration with existing hospital technologies, including the electronic health record (EHR) and hospital scheduling software.

2. Virtual hospital sitters. UCSF and other health systems spend millions of dollars each year hiring people to sit at the patient bedside to monitor for falls, self-harm, or other deleterious behaviors. If sitters could be partially replaced with robots or other virtual technology, UCSF could keep patients safe while saving huge amounts of money on workforce costs.

3. Artificial intelligence for the hospital. Advances in machine learning and artificial intelligence (AI) have opened the door for predictive modeling to enhance patient care. From ICU monitoring systems that model patients’ vital signs and produce patient-specific care recommendations, to identifying patterns in care that can have significant impacts on patient outcomes, the future potential for AI in health systems is substantial. Beyond the use of patient data, Sheila and her colleagues expressed interest in AI for the hospital environment – a system in which the environment adapts to patient needs. Such technology could be used for better managing inpatients with pain, delirium, or for promoting mobility for hospitalized patients.

4. Automated documentation within the electronic health record. It’s well accepted that both nurses and physicians spend too much time documenting in electronic health records (EHRs). Nurses, in particular, spend large amounts of time transcribing information from pumps and other patient devices to the EHR. Automated documentation between connected devices and the EHR would improve workforce efficiency and also allow hospitals to more quickly and accurately assess risky states for the institution and the patient, and optimize accordingly. Why hasn’t this happened already? EHR integration between devices is notoriously cumbersome, leaving nurses to take on this effort manually.

5. Virtual home-health communities. Telehealth is rightly a huge area of interest for healthcare innovation. But most telehealth companies are focused on 1:1 patient and provider visits. We see a future in which one provider is able to hold virtual group visits, for example for patients discharged from the hospital with similar conditions. Using population health management tools and the hospital discharge team, these patients could also be matched with a community of patients in their neighborhood, or connect with each other through a virtual platform with relevant resources and communication functions.

6. Price transparency tools for the inpatient setting. There needs to be a better way to track the costs patients face on an ongoing basis. In addition, price transparency tools need to interface with EHRs. Differing reimbursement offered by different plans to each health system have made this issue an ongoing challenge for patients and providers.

7. Pain management dashboard. Current stand-alone technologies exist for chronic disease management, but a pain management dashboard embedded within the EHR could lead to a better and safer tracking of patients with chronic pain issues. With the growing pain medicine epidemic, better and safer pain management is hugely important. Right now, pain management is a fragmented process, requiring patient, pharmacy, nursing, and provider input. An integrated dashboard that allows for cross checking with outpatient pharmacies and the CURES database, pain scoring, and ordering would help ease this currently manual process.

8. Technology to enable safe patient handling. Care teams constantly have to move, position, and lift patients —  even when they shouldn’t. And these tasks can be taxing to staff and result in significant hospital liabilities. Similarly, the safe handling of hospital waste is still a very manual process. Robotic technologies that automate these tasks are appealing from a time, cost, and safety perspective.

9. Research management application. For providers and care teams, it is difficult to know if a patient is enrolled in a clinical trial, which can create significant safety issues. For example, if a patient enrolled in a clinical study is admitted to the hospital and is administered a medication that interacts with a study drug, the patient could be at significant risk for a drug interaction. At present, there is no automated way of managing and flagging patients enrolled in trials. With a better research management application that connects to the EHR, an automated research interface would flag patients who are part of a trial and provide additional supporting materials regarding safety measures that must be followed.

10. Apps for frontline staff. Frontline nurses attend to almost all of a patient’s basic needs. In doing so, they often juggle up to 25 pieces of paper with critical information. Ideally, nurses could use charting software that would help manage and streamline all this information.

Motherhealth is looking for investing partners, doctors and developers for a Health Mobile Outpatient application that will match, monitor and report patient generated health data, including video chats with care providers, cancer care coordination analytics, genetic and lab tests health data sharing and more. Email Connie Dello Buono at ; 1708 Hallmark Lane San Jose CA 95124

There is hope when you have no medical insurance

What to do if you have no health insurance but still need medical care”…. This subject is very near and dear to my heart.

As a nurse, I know how important it is to do whatever you have to do to stay healthy. Neglecting to stay on top of a “small” medical condition like a simple cough that won’t seem to go away can turn into a life-threatening pneumonia.

But I also know that paying for medical care is very expensive. When you have to decide whether to pay for your blood pressure pills verses food for your family or gas for your car, trying to do the right thing can become blurred.

There is hope!

There are a growing number of assistance programs to help those with no health insurance, or those who need assistance paying their premiums or co-payments. Hopefully, the resources and recommendations provided here will help make the decision to stay on top of your health clearer and easier.

    • provides a state-by-state directory which answers many of your insurance questions and provides contact information. Some of the topics it addresses include considerations with COBRA and if alternatives are better for your circumstances, determining eligibility in programs based on the Federal Poverty Level, are you and your family eligible for Medicaid, how to apply for children’s healthcare coverage and more.To find out more go to:
    • If you have children but have no health insurance, Insure Kids Now is a wonderful resource.Insure Kids Now is a state and Federal government program which provides medical, dental and psychological care for children through the Children’s Health Insurance Program (CHIP).Their website includes how to apply for coverage, finding healthcare providers in your area and more. To learn more, go to their website at or to find how to apply for coverage go to
    • In 1993, legislation was passed to allow states to create a safety net for individuals who had been, or could be, denied healthcare coverage due to pre-existing conditions. Many states now have their own High Risk Pool ( for those with no health insurance or those who are facing high insurance costs due to pre-existing conditions.States contract with major insurance carriers to manage the high risk pool programs and offer plans that are similar to individual policies offered by these carriers. You can even choose your own deductible.The plans are created to be affordable while providing you with comprehensive healthcare coverage.To see if your state participates in the High Risk Pool program you can go to or, to learn more about the High Risk Pool program you can go to:
    • Free clinics are also an option if you have limited health coverage or no health insurance. The United States Department of Health and Human Resources provides a list of free clinics in your area. To find a health center in your area go to: If you are a member of a federally-recognized American Indian or Alaska Native Tribe, services are also available through the Indian Health Service.
  • No health insurance? This is not a problem for most urgent care facilities. Most facilities are able to offer cash paying patient 20% off of their services and will work with you to provide you with the care you need.
  • Some urgent care facilities will offer a family package. Your package would include basic exams plus any urgent care you or your family may have throughout the year.My husband and I have been very impressed with the compassion and high quality care provided by the urgent care facilities near our home.Check with your local urgent care provider to see what they have to offer.
  • Nonprofit hospitals must provide you with emergency medical care regardless of your ability to pay. Often times these facilities are able to write off a certain portion of your bill and/or help you set up low payment plans if you are able to provide them with proof of your income.Some physicians may be willing to negotiate a lower rate for uninsured, cash-paying patients. This website, written by 2 doctors, should give you good reason to ask for a lower rate if you have no health insurance. It’s becoming more widely known about the disparity in the charges for healthcare costs for those with insurance and those without.Whether you are negotiating rates with a lab or healthcare provider, the Healthcare Blue Book is a wonderful resource to help you determine the cost of medical services in your area. Having an idea of how much things cost can help you with your negotiations. The Healthcare Blue Book includes the cost of basic labs, dental services and more.For a percentage of your bill, you can hire a medical negotiating company to assist you in evaluating whether or not you have been over-charged and help you with the negotiating process.

    If you would prefer to use one of these agencies or you just want to see what they have to offer, you can find a list of medical negotiation companies at

  • There are more and more financial assistance programs available to those with no health insurance in need of help with dental care, prescription coverage, medical care, mental health needs, and even vision.I have listed quite a few resources located at the bottom of this page and will continue to add to them as I find more and more.If you would like to find some resources on your own and share them with others, you can Google® “patient assistance programs”.Don’t forget that Schools of Dentistry and Medical Schools can often provide you with free care!

    Some church organizations can also be a resource for individuals in need of counseling and support.

  • Prescription assistance and numerous $4 generic drug programs are popping up everywhere! The $4 generic drug programs are available to those without healthcare or those without prescription coverage on their health plan. Some of the bigger $4 programs include Target, Kroger, Safe-way and Sam’s Club/Wal-Mart.Many of the larger pharmacies such as CVS, Target, Walgreens and others offer American Automobile Association club members (AAA) prescription discounts.RxAssistance ( is run by pharmaceutical companies. The program provides free medications to those who cannot otherwise afford their prescription drugs.
  • “Millions of patients with rheumatoid arthritis, psoriasis and inflammatory bowel disease can be excited today because new research in the Annals of Internal Medicine shows that biosimilars are just as safe and effective as many of the expensive brand biologics prescribed for these conditions.

    The Biosimilars Council is pleased to see more science-based evidence that patients can trust biosimilars and that providers can confidently prescribe these medicines. This data reinforces the importance of core scientific principles such as bioequivalence and can help inform policymaker efforts to encourage patient access and promote biosimilar competition.”

    Other prescription programs include: RxHope (, NeedyMeds ( and RxOutreach Assistance Program for Discount Prescription Drugs (

    Many pharmaceutical companies such as Pfizer, and Merck also provide patient assistance programs. You can always check with the pharmaceutical manufacturer of brand name drugs to learn more about their programs for those with no health insurance, or if you need help with health coverage.

    While we are all facing challenging times, the good news is, with the growing number of assistance programs available your health does not have to suffer!

  • Older Americans with no health insurance can check for those resources and long-term care benefits and help with paying for food at and

Resources The National Association of State Comprehensive Health Insurance Plans provides this link for a state-by-state break down. If you would like to know more about the high risk program you can go to their site at The National Library of Medicine (NLM) and National Institute of Health is a great “one-stop shopping” site which provides you with links for Medicaid, Children’s health assistance programs, disease-specific assistance and more. go to the Affiliate Search section of Mental Health America’s website to find treatment, support groups and a host of other resources available to low income individuals or individuals with no health insurance who find themselves in need of counseling or support. The Health Resources and Services Administration (HRSA) provides a link to help you find a community health center in your area. Your local community health center can help address not only you physical, but your mental health issues as well. The Body provides a state-by-state directory of resources available to those with HIV. The National Kidney and Urological Disease Information Clearing House provides listings of patient assistance programs (PAP’s) for those with kidney disease who are in need of medical and prescription coverage in addition to links to Medicare and Medicaid. Needy Meds is a non-profit organization which provides resources for those who cannot afford medical care or prescriptions. Their website provides links to SCHIP, Medicaid, patient advocacy groups and other programs. Partnership for Prescription Assistance provides links to co-payment programs in addition to links for financial assistance for prescription medications. Carington Dental Plan provides affordable dental, vision and prescription coverage.

I was happy to see that there are quite a few dentists who are participating in this program including my dentist! HURRAY! Now I can get my teeth taken care of too! Eye Care America provides links for resources (financial assistance and more) for seniors, patients with diabetes, glaucoma, medication assistance and more for those with vision care needs. Vision USA is another organization which helps provide eye care to those who do not qualify for Medicaid. You can go directly to the website for the Children’s Health Insurance Program (CHIP) to learn more about the program including how to apply for dental and medical care for your child. CNN has provided a wonderful article entitled “No Health Insurance? Get help here” This is a wonderful article which provides ideas on ways you can lower your healthcare costs if you have limited coverage or no health insurance. HealthWell Foundation is a non-profit organization that assists those with insurance who are unable to afford their co-payments. FamilyWiz is a non-profit organization that provides free prescription discount cards. The cards can be used by those with no health insurance, and for those with healthcare coverage during deductible. This site will tell you more about the program and where to find the cards! Patient Advocate Foundation (PAF) Co-Pay Relief (CPR) program provides financial assistance for those who meet the medical and financial qualifications. PAF covers a vast array of healthcare conditions. Go to their website to see if you qualify. The National Center for Complimentary and Alternative Medicine (NCCAM) provides information about sources for financial assistance for complementary and alternative medicine. Health Resources from the Government is an absolute treasure chest of information!! Information on childcare, health insurance, vaccines and immunization, doctors and medical facilities, health issues, medication and food and nutrition can be found here.

Islets of Hope provides an extensive list of resources for persons with diabetes, including state-by-state resources, Canadian and New Zealand resources, charitable and private resources (including those for pump supplies), etc. An extensive source, especially if you have no health insurance and are trying to pay for diabetic supplies.

An additional page of resources can be found at ‘Insurance Resources’, which provides links to other organizations and government agencies.

Motherhealth – Health Mobile Outpatient application (in development) is inviting all doctors to join and provide video chat with patients and simple out-of-pocket costs for patients. Email


Health Insurers Performance 2012-2014 OBAMACARE

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Over a third of the total sample (53 insurers, groups 1 and 2) were profitable in 2014; these insurers accounted for 41 percent of the total members in this sample (data not shown). The remainder were either unprofitable both years or moved from profit to loss. Medical claims, rather than administrative costs, were the main driver of the negative financial experiences.


Most of insurers’ underestimated claims in 2014 were offset by $7.9 billion in reinsurance payments for high-cost patients from the federal government. The reinsurance program helps insurers transition to the new market rules, using federal funds collected through an earmarked fee on all health insurance, included self-funded plans, to pay a large portion of high-cost claims incurred in the individual market.

Insurers that turned profitable in 2014 (group 1) saw their medical costs decrease by almost 12 percentage points as a percentage of premium—that is, their MLR decreased. Coupled with a 1.4 point decline in the mean administrative cost ratio, these changes resulted in a substantial (13.2-point) rise in their overall profit margin to 7.6 percent, from a loss of 5.6 percent. In contrast, insurers that reported losses (groups 3 and 4) had substantially higher mean MLRs. Although they managed to reduce their administrative costs significantly, their MLR increased even more, producing a mean loss greater than 10 percent.


 By subsidizing coverage, establishing insurance exchanges, and making insurance available to people with preexisting conditions, the ACA’s reforms changed market conditions in ways that insurers had difficulty predicting, at least initially. In 2014, the ACA’s reinsurance program offset much of insurers’ underestimated medical claims in the individual market. Also, despite overall losses in the individual market, the insurance industry as a whole earned modest operating profits (in addition to profits from investments).

 Only some insurers fared especially poorly. One-quarter of insurers underestimated medical claims in the individual market to a much greater extent than the rest. A fifth of insurers in the individual market substantially improved their financial performance between 2013 and 2014.

 All well-functioning markets have winners and losers, so it should be no surprise that some health insurers failed to succeed in the ACA’s reformed market, especially during the first year. As insurers gain greater experience with these new conditions, it can be expected that their actuarial precision will improve and that large differences in financial performance will diminish. Moreover, additional market stabilization can be expected as more previously insured people move out of grandfathered and transitional plans and into ACA-compliant coverage.

 However, improved financial performance will require increased premiums, especially as the ACA’s reinsurance component phases out, starting in 2017. This reinsurance has played a crucial role in helping insurers transition. Because this has taken longer than initially expected, policymakers should consider extending the ACA’s reinsurance program until the reformed market has matured.


What a connected patient wants?

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Motherhealth LLC – Health Mobile Outpatient application (in design stage) will address the needs of connected patients in today’s health care with video chats, electronic communication/appointment and data storage and an integrated system to reduce chronic care costs and increase preventive measures towards saving lives.

  • Match care provider and patients , electronic appointment, video chats
  • Monitor patient generated health data integrated with doctors health data
  • Report analytics , personalized and for global cancer care coordination

Email if you are a doctor or investing partner or a mobile health developer.  All doctors are welcome to be part owner of this health application.