December 2008 News You Can Use
New Law Expands Mental Health Parity
[Emergency Economic Stabilization Legislation, Pub. L. No. 110-343, Div. C (Oct. 3, 2008)] http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=110_cong_bills&docid=f:h1424enr.txt.pdf
The mental health parity requirements for group health plans have been expanded as part of legislation signed by President Bush on October 3, 2008. The legislation adds new requirements regarding mental health and substance abuse benefits beginning after October 3, 2009. Here are some highlights:
Substance Use Disorder Benefits. The existing mental health parity provisions have been expanded to apply to substance use disorder benefits. Other changes made by the new law also apply to substance abuse benefits.
Parity in Financial Requirements. Plans must ensure that the financial requirements that apply to mental health/substance abuse benefits are no more restrictive than the requirements for medical and surgical benefits covered under the plan. "Financial requirements" includes deductibles, co-payments, co-insurance, and out-of-pocket expenses.
Parity in Treatment Limitations. Likewise, the treatment limitations that apply to mental health or substance abuse benefits may not be any more restrictive than the limitations that apply to medical and surgical benefits, and plans may not have separate treatment limitations that apply only to mental health or substance use disorder benefits. This includes limits on the frequency of treatment, number of visits, days of coverage, or other similar limits.
Plan Information. The medical necessity criteria must be made available to current or potential participants, beneficiaries, or contracting providers upon request. The reasons for any denial must also be made available to the participant or beneficiary on request.
Out-of-Network Providers. If a plan offers coverage for out-of-network medical/surgical benefits, then coverage must also be provided for out-of-network mental health or substance use disorder benefits.
Small Employer Exemption. The parity requirements include an exemption for small employers that employ an average of at least 2 employees but no more than 50 employees.
Cost Exemption. A more detailed cost exemption is available if a plan complies with the requirements for the first six months of the plan year and the increased cost of applying the parity requirements exceeds 2% of the actual plan costs in the first plan year in which the requirements are applied; and 1% in each subsequent plan year. Plans that qualify for the cost exemption must provide notice to governmental agencies, participants, and beneficiaries.
There will be more guidance to come—the legislation directs DOL, HHS, and the Treasury Department to issue regulations within a year of the law's enactment. Source: EBIA
Pregnancy Discrimination
Pregnancy discrimination is often unintentional – but none the less deadly. I heard a supervisor not long ago tell an employee, “If I had known you were pregnant, I wouldn’t have hired you.” He thought he was being funny – unfortunately only he got the punch line.
The number of pregnancy discrimination complaints filed with the U.S. Equal Employment Opportunity Commission (EEOC) rose sharply from fiscal 1992 to 2007, says a new report released on the 30th anniversary of the Pregnancy Discrimination Act.
Among that data:
• During the past fiscal year, pregnancy discrimination charges rose to a record high of 5,587.
• Fiscal 1992-2007, there was almost a 65 percent increase in charges filed.
• Fiscal 1996-2005, 38 states recorded an increase in pregnancy discrimination charges filed with the EEOC, and 13 states and Puerto Rico saw increases of more than 50 percent in charges filed.
The increase in complaints outpaced the increase in women to the workforce, according to findings. During that time, the percentage of women in the labor force, employed or looking for work actively, increased from 57.8 percent to 59.3 percent.
Much of the increase in claims of pregnancy-only discrimination came from women of color. From fiscal 1996-2005, complaints filed by black women increased by 45 percent; by Hispanic women, 135 percent; by Asian/Pacific Islander women, 90 percent; and by American Indian/Alaska Native women, 109 percent.
The report found that the presence of large numbers of women workers in an industry does not guarantee greater sensitivity to pregnancy discrimination laws. Three of the industry categories the EEOC tracked—service; retail trade; and finance, insurance and real estate—are female-dominated industries, but had the highest number of pregnancy discrimination claims. Manufacturing was the fourth.
Cost of diabetes care doubles in past 6 years
According to Archives of Internal Medicine, Americans with diabetes nearly doubled their spending on drugs in just six years, last year climbing to $12.5 billion. And in recommendations, an expert panel told doctors to use older, cheaper drugs first.
Newer, more costly drugs are driving the increase, though there is a lack of strong evidence for the new drugs' greater benefits and safety. Also, more people are being treated for diabetes.
Metformin (about $30 a month)—an inexpensive generic used reliably for decades—may prevent deaths from heart disease while the newer, more expensive Avandia, which costs about $225 a month, didn't show that benefit.
Researchers from University of Chicago and Stanford University studied which medications doctors prescribed and total medication costs. Diabetes drug spending rose from $6.7 billion in 2001 to $12.5 billion in 2007, a period when costs dropped for metformin.
Nearly 24 million Americans, 8 percent of the population, have Type 2 diabetes, which can lead to kidney failure, blindness and heart disease. Employers should take steps to help employees manage their health, reducing benefit costs for this population.
Nursing Moms’ Rights
A growing number of states—in recognition of the health benefits of breastfeeding for the nursing mother and child—have passed specific laws giving nursing mothers the right to breastfeed and/or express breast milk in the workplace. Gov. Mitch Daniels added Indiana to the growing list of states with these laws.
The law requires private businesses with 25 or more employees to make reasonable efforts to provide a private location, other than a toilet stall, where an employee can express breast milk during any period away from the employee’s assigned duties. Further, Indiana’s law is the first of its kind to require employers to accommodate the storage of breast milk. It requires that, to the extent reasonably possible, an employer must provide a refrigerator or other cold storage space for keeping milk that has been expressed or allow the employee to provide her own portable cold storage space. The law does provide that “except in cases of willful misconduct, gross negligence, or bad faith, an employer is not liable for any harm caused by the expressing of an employee’s breast milk or the storage of expressed milk. The Indiana law also requires state and political subdivisions to provide additional accommodations. Public sector employers must provide reasonable paid break time each day for an employee to express breast milk and a location for doing so in close proximity to the employee’s work area.
Many states have enacted laws protecting a nursing mother’s right to breastfeed and/or express breast milk in the workplace. Doctors and health care professionals recommend that all babies be exclusively breastfed for a minimum of six months. All states with lactation accommodation laws require employers to provide this for at least one year, but some states do not impose any time limits for the accommodations. The following states also have lactation accommodation laws for nursing mothers: California, Connecticut, Georgia, Hawaii, Illinois, Minnesota, Mississippi, Oklahoma, Rhode Island, Tennessee and Virginia. Source: Mendy L. Mattingly and Lisa M. Brauner, Littler Mendelson
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