Patient Abuse Is Tragic: A Call to Action. To friends and foes alike (for it matters not, if you are willing to help).                                                                                  The following was passed my way by the good folks at The David Balezon Center for Mental Health Law in New York City. Please take a moment or three to consider the information below, and if you can, participate in the process to the best of your ability.  The Bazelon Center for Mental Health Law www.bazelon.org/ Legal advocacy for the civil rights and human dignity of people with mental disability. December 20, 2012 -- The U.S. Department of Health and Human Services (HHS) has proposed a rule outlining standards related to development and coverage of essential health benefits (EHBs) under the Affordable Care Act (ACA). Per the ACA, all new health insurance plans offered in the small group and individual markets are required to offer a package of essential health benefits, including mental health and substance use disorder services at parity (i.e., on par with other surgical/medical benefits), beginning in 2014. However, many of the proposed rule's protections for insurance consumers and beneficiaries with mental illnesses could be much stronger.   Thus, we strongly encourage organizations and individuals to submit comments on the proposed rule before the deadline: 5 p.m. (Eastern Standard Time), December 26, 2012.   Click here to submit your comments to HHS online. You may also go to www.regulations.gov and enter "CMS-9980-P" in the search box in the upper-right-hand corner. When you see the proposed rule, click "Comment Now" and follow the instructions to submit your comments. Major points to include in your letter to HHS:  Applaud HHS for acknowledging the application of the Mental Health Parity and Addiction Equity Act (MHPAEA) to EHB plans. Urge HHS to clarify and provide additional guidance on the application of MHPAEA to EHB-benchmark plans.  The ACA prohibits health plan issuers from designing EHB-benchmarks in a way that discriminates against individuals based on disability. Strongly encourage the federal government to play a significant role in establishing and enforcing the ACA's nondiscrimination provisions. Recommend the development of a strong nondiscrimination standard that should be used to determine if coverage complies with the nondiscrimination requirements of the law. This includes ensuring that plans do not make coverage decisions or establish reimbursement rates that result in people with mental illnesses being needlessly served in segregated settings.  Encourage HHS to reassess the EHB selection approach critically in advance of the 2016 plan year and strongly urge HHS to adopt a comprehensive national EHB at that time. Urge HHS to describe the criteria by which the current approach will be evaluated. The proposed rule requires that a state selected benchmark plan that is missing an entire category of EHB must be supplemented by lifting the whole missing category from another benchmark plan option. The rule does not, however, provide a process for supplementing plans that provide only minimal coverage. Urge HHS to define a standard of adequacy that requires coverage of certain benefits in each category. If a base-benchmark does not include those benefits in a benefit category, urge HHS to require that the benefits in that category be supplemented to bring it into compliance. See the Bazelon Center's recommendations here on mental health services that should be included. Urge HHS to clarify that the mere inclusion of any service in a category of EHB does not meet the EHB consumer protection requirements of the law. The final rule should clarify that EHB must include sufficient services in each category to meet federal requirements, including: (1) that mental health and substance use disorder services be provided at parity with medical services in each category, (2) that coverage decisions, reimbursement rates, and benefit design not discriminate based on disability, and (3) that EHB take into account the health care needs of persons with disabilities. Urge HHS to clarify that the EHB must cover all of the benefits within categories that list more than one benefit, such as "mental health and substance use disorder services," in order to satisfy EHB requirements. The rule should state that plans are not EHB-compliant unless they cover both mental health services and substance use disorder services, as opposed to only covering, for example, substance use disorder services. Urge HHS to reconsider allowing plans to define habilitation services. Urge HHS to develop careful standards governing flexibility to substitute benefits within categories. Standards should ensure that plans cannot use this flexibility to avoid serving higher-risk beneficiaries. Recommend that HHS adopt the Medicare Part D standard as the standard for prescription drugs in the EHB-benchmark.  Medicare Part D requires "all or substantially all" medications in six categories including those most relevant to individuals with serious mental illnesses: antidepressants, antipsychotics and anticonvulsants. Strongly support the proposal to consider as essential health benefits all state-required benefits enacted on or before December 31, 2011.  Resources  HHS has specifically requested comments from state advocates on all possible EHB plans each state can select, as well as combinations of plans that a state can use to supplement missing benefits. Information on each state's proposed EHB benchmark plan and links to proposed benefits are available here. Access a list of states' three largest small group planshere. Also, see the health reform section of the Bazelon Center website. Thank you! IN CLOSING: As always, there is work to be done on all fronts when it comes to addressing the endemic shortcomings of America's very fabric in terms of our nations' most seriously mentally ill citizens. As only the most tragic events on our soil can seemingly state, there is a crisis at hand, and in the context of the mentally ill, I attest to the fact that in places like Arizona- and despite extensive funding sources and related laws and policy specific to the public health care system in general- the finger can be directly pointed at the graphic failings of the various mental health care professionals and related state officials who we, the public, have granted our trust in when in comes to caring for and treating this exclusive population. Please do you part today to see that these matters are addressed, with specific respect for the tragedy befalling the citizens being treated at The Arizona State Hospital, because Patient Abuse is Tragic in all senses of the term. The administrators and senior clinicians at ASH and throughout the Arizona Department of Health Services/Behavioral Health Services are still maintaining the substandard mental-medical conditions and practices, and they are getting away with it lock-stock-and barrel. paoloreed@gmail.com