Alaska Mental Health Consumer Web

Mental Health Parity Task Force Committee in Progress

Mental Health Parity Task Force
Wednesday, January 13, 1999
 Meeting Agenda

Legislative Information Office
716 W. 4th Avenue, Room 220
Anchorage, Alaska

8:00 – 9:30 am Task Force Discussions/Business
10:00am – Noon Testimony – Priority given to telephone testimony
Noon – 1:30 pm Lunch
1:30 – 3:30 pm Testimony – Priority given to in-person testimony
3:45 – 5:00 pm Task Force Discussions/Business
5:00 pm  Adjourn

Task Force Recommendations as of 12/30/1998

General.  The Task Force, having studied the various issues and elements of mental health parity, developed a set of three different models for initial consideration.  All three models have some common features:

Model 1: Federal Legislation Extended.  The first model presented for consideration would be the extension of the terms of MHPA of 1996 (federal legislation) to Alaskan firms with 20 or more employees.  This would involve equating annual and lifetime dollar limits between mental and physical health.  As noted above, it would also mandate that mental health coverage be provided in health care plans provided by firms subject to the mandate.  It would also be considered with and without substance abuse inclusion.

Model 2: Catastrophic Model.  The next model would add, in addition to the elements of MHTA noted above, parity with regard to days and visit limits and maximum out-of-pocket expenses.

Model 3:  Financial Parity.  This model would add, in addition to the elements of the two models noted above, parity with regard to co-insurance, co-payments, and deductibles.

Very Poor Attendance on 12/30/ 98 Meeting

Representative Tom Brice, Joe Heueisen, Banarsi Lal, Katsumi Kenaston ( 4 out of 10 board members and Walter Majoros, AKMH Board,  contractor Steve Hamilton) discussed the draft report of  contents including Parity Background, Legislation, Options, Cost, Impact and Recommendation.  Since this report is not completed, it is very difficult for me to state my opinion.  Also, the State Division of Insurance is absent from the arena for a long time.  They could share their statistics, experiences and wisdom to educate a person like myself as we worked very hard to bring this Parity Task Force to reality.  Katsumi Kenaston, Consumer Board member

Next Meetings

12/30/98, Wednesday  Teleconference  10 am. to 12 noon                 (Draft Report ready on 12/25/98)

1/13/99, Wednesday  In Person Meeting and Public Comment Time included,  at the Legislative Information Office in Anchorage  for more info, call 272-8216

2/1/99, Monday (tentative)  The Task Force Last Meeting

The Task Force terminated  on 2/28/99

Mental Health Parity Task Force
Monday, December 7, 1998
 Meeting Agenda

Alaska Psychiatric Institute, Room 3123
2900 Providence Drive
Anchorage, Alaska
9:30 am – 4:30 pm

Morning Agenda Items

I. Call to Order

II. Review of Data

III. Report Format/Contents Proposal and Discussion
Lunch at API
IV. Policy Issues Discussion
  V. Implications for State Employee Health Insurance

VI. Draft Report – Instructions to the Contractor/Distribution

VII. The Next Step/Timetables

VIII. Adjournment

Mental Health Parity Task Force
Monday, October 26, 1998
Legislative Information Office
Anchorage, Alaska
1. Call to Order.  The October 26, 1998 meeting of the Mental Health Parity Task Force was called to order by Co-chair Senator John Torgerson at 10:50 am in the conference room of the Legislative Information Office in Anchorage, Alaska.
2. Attendance.  The following Task Force Members and Support were present:
Senator John Torgerson   Representative Tom Brice
Senator Johnny Ellis    Joe Heueisen
Dr. Cynthia Dodge    Banarsi Lal
Katsumi Kenaston    Patrick Murphy
Steven Hamilton (Contractor)   Matt Felix (Contractor)
Mary Hamilton (Contractor/Recorder)
3. Approval of Agenda.  The proposed agenda was accepted as presented.
4. Presentation of Work Plan.  Steven Hamilton of C & S Management Associates presented a proposed work plan showing tasks, responsibilities, and timelines.  The Task Force directed that the plan be modified to delay the scheduled November meeting until December 4.  All other elements remained the same.  The plan was approved as modified.
5. Information Needed by National Contractor.  Steven Hamilton presented to the Task Force the requirements of the National Contractor in terms of needed information for modeling the costs of any proposed legislation.  The required elements are:
A. Number of Lives Covered under Existing Policies
B. General Structure of Existing Policies
C. Current Cost of Claims
D. Basic Elements of Proposed Legislation
E. Number of Employers/Employees (Size of Firms)
6. Discussion of Parity Issues.
A. Definition of Mental Health.  The Task Force discussed the issue of defining mental health with several options presented ranging from a strict, “seriously mentally ill” approach to a more flexible approach which includes all disorders identified in the DSM IV Manual.  The group agreed to proceed with the assumption of a definition that includes all disorders listed in DSM IV with the exception of “V Codes,” which are not usually covered by health insurance policies.  This decision was based on the assumption that cost containment of any mental health parity legislation could be accomplished by any of several other means.
B. Substance Abuse Inclusion.  Steven Hamilton presented the group with a copy of existing legislation (A.S. 21.42.365 Coverage for treatment of alcoholism or drug abuse).  This legislation provided for mandatory inclusion of substance abuse treatment in health insurance policies and included elements of parity.  Since the cost estimates for any parity legislation prepared by the national contractor will include provisions with and without substance abuse, the Task Force decided to keep substance abuse under consideration for now.
C. Size of Employer Applicability.  There have been several cutoffs in terms of exemptions for small employers.  The federal legislation defines small employers (for purposes of exemption) as 50 employees, while other states have gone as low as 5.  The existing legislation on alcoholism coverage (see B above) uses 20 employees as the break point.  The Task Force decided to tentatively use this figure as the basis for modeling costs.
D. Other Cost Containment Features of Parity.  Several other areas of parity that can be used to control costs are the applicability to co-payments/co-insurance, deductibles, lifetime policy limits, and maximum out of pocket expenses.   In examining Mr. Bachman’s models, the Task Force noted that Bachman’s “Catastrophic” model includes parity in days/visits, lifetime and annual limits, and maximum out of pocket expenses.  His “Financial Parity” model adds parity for co-insurance/co-payments and deductibles to the “Catastrophic” model.  For purposes of analyses, the Task Force requested that Mr. Bachman develop costs for parity which (1) mirrors the federal minimum requirements; (2) contains the elements of “Catastrophic” parity; and (3) contains the elements of “Financial” parity.  They directed Mr. Hamilton to enter into discussions with Mr. Bachman regarding these options.
7. Public Testimony.  The Task Force began taking in-person public testimony at 3:00 pm.  During the period 3:00 to 5:00 pm, a total of 9 persons signed in with 3 of those testifying before the Task Force.  The Task Force re-convened at 7:00 pm to take both in-person and phone-in testimony.  During the period 7:00 to 9:00 pm, one person testified in person and 19 persons called in, of whom 18 gave testimony.
8. Adjournment.  The Task Force meeting was adjourned at 9:00 pm.  The next scheduled meeting of the Mental Health Parity Task Force will be at 9:30 am on Friday, December 4, 1998 at the Alaska Psychiatric Institute (pending arrangements).  A teleconference meeting may be called during November if the need arises.

Respectfully Submitted,

Steven Hamilton
C & S Management Associates

Mental Health Parity Task Force
Monday, October 26, 1998
 Meeting Agenda
Legislative Information Office
716 W. 4th Avenue, Room 220
Anchorage, Alaska

9:30 am – 2:45 pm Task Force Meeting
 Call to Order
 Approval of Agenda
 Presentation of Work Plan – C & S Management Associates
 Information needed by National Contractor
Discussion of Issues
? Definitions used:  Mental Disorders versus Seriously Mentally Ill (SMI)
? Services Covered:  Experiences of Other States
? Needed Data  (lives covered, description of plans, utilization) – Approach/Problems
? Mandatory versus Optional Coverage; relationship to parity
Next Steps; agenda items for next meeting

Note:  Lunch will be ordered in

In-Person Public Testimony: 3:00 – 5:00 pm

Call-in and In-Person Public Testimony: 7:00 – 9:00 pm

Public Testimony Needed!

        October 14, 1998
Dear Mental Health Stakeholders,
The Mental Health Parity Task Force is seeking public testimony on Monday,
October 26, 1998. The Task Force was established by the 20th Alaska
Legislature to study the differential treatment of mental disorders versus
physical disorders in health insurance coverage, and make recommendations
to the 21st Legislature on how this issue should be addressed in Alaska.
The Task Force is interested in hearing testimony from those individuals
and organizations who have past experience concerning mental health
coverage (or lack thereof) in private insurance, and those who would be
impacted by potential parity legislation.  The Task Force is especially
interested in hearing from mental health consumers and providers. Please
share the information below with all those who you feel might be interested
in testifying.
Date:   Monday, October 26, 1998
Times:  3:00 to 5:00 p.m.       In-person Public Testimony
                        Legislative Information Office
                        716 W. 4th Avenue, Room 220
        7:00 to 9:00 p.m.       Call-in and In-person Testimony
        Call in number: 1-800-315-6338, followed by 727489#
        In-person testimony at same location listed above
Thank you for your assistance and please contact me at 465-3072 if you
would like any additional information.

        Walter Majoros
        Executive Director

 Next Meeting

October 26, 98   at the Legislative Information Office,  716 E. 4th Avenue, Room 220  Anchorage

Time:  9:30 am. to 2:45 pm Task Force Meeting with Working Lunch
          3:00 pm. to 5:00 pm. In-person Public Testimony
          7:00 pm. to 9:00 pm.  Call-in and In-person Testimony

Mental Health Parity Task Force
Thursday, October 1, 1998
Teleconference Meeting
1. Call to Order.  The teleconference meeting of the Mental Health Parity Task Force was called to order at 11:09 am by Representative Gary Davis, Co-Chair.
2. Attendance.  Attending the teleconference were:
Representative Gary Davis, Co-Chair   Senator Johnny Ellis
Representative Tom Brice    Dr. Cynthia Dodge – Provider
Joe Heueisen – Insurance Industry   Pat Murphy – AMHB
Elmer Lindstrom – DHSS    Walter Majoros – AMHB
Katsumi Kenaston – Consumer   Banarsi Lal – ABADA
Steven Hamilton – C & S Management Associates Sharon Macklin – Bridges Campaign
Julie Tauriainen – Rep Davis Staff   Pat Ryan Clasby – ASHNA
Matt Felix – C & S Management Associates
3. Introductions.  Members of the task force, staff, and contractors introduced themselves briefly before taking up items on the agenda.
4.  Review of Services.  Steven Hamilton, owner and principal of C & S Management Associates, reviewed the scope of work and services to be provided under the contract.  Several points of direction were given by the Task Force:
? Avoid duplication and reinventing; there are many studies that can provide excellent information and insight.  Use existing studies and verify the experiences of other states to the extent possible.
? Once the Task Force has arrived at a recommendation or series of recommendations from which legislation can be developed, the contractor will be expected to support those positions through testimony before legislative committees.
? In addition to gathering data, special effort should be made by the contractor to contact providers, consumers, and advocates to obtain qualitative information regarding the impacts of mental illness and insurance limitations on people’s lives.
? The contractor will examine the issue of inclusion or exclusion of substance abuse in any parity recommendations and present information and data to address parity both with and without substance abuse.
? Coordination with PricewaterhouseCoopers, who are conducting the national actuarial study, should begin as early as possible to ensure that the Alaska-specific information and assumptions are conveyed in time for a meaningful analysis to take place.
? In addition to public comments on the draft report, public testimony will take place at the first face-to-face meeting, following the completion of business.  This will allow interested members of the public, consumers, providers, and other stakeholders to comment at the earliest stages of the project.  During this public meeting, priority will be given to those individuals who have not been contacted and interviewed as key informants.
5. Communications with Contractor.  Walter Majoros agreed to act as primary liaison to the contractors, C & S Management Associates.  Walter will provide contact information for other key individuals, such as legislative aides, to the contractor.  Steve will distribute both meeting minutes (target 7 days following meetings) and meeting packets (7 to 10 days prior to meetings) by mail.
6. Verification of Key Policy Issues.  Based on the prior two Task Force Meetings, a set of key policy issues has been developed and was included as part of the issues to be addressed by the contractor.  The Task Force again reviewed and, in some cases amplified, these issues during the teleconference:
(a) Definition of Mental Illness – Pat Murphy expressed the hope that the group not get bogged down in the details of mental illness definitions; the true issue is parity.
(b) Inclusion or Exclusion of Substance Abuse – Banarsi Lal reiterated the expectation that the contractor would examine the issue of parity both with and without substance abuse included and present information to cover both possibilities to the Task Force.
(c) Definition of Eligible Expenses – Representative Brice asked for amplification on this issue.  Does this define who is a provider? What services are provided?
(d) Definition of Existing Employer Pool – Considerable discussion took place regarding potential employers who may or may not be covered under any proposed parity legislation in Alaska.  Examples of such organizations include State of Alaska employees or municipalities who are self-insured.  Steve indicated that his first step would be to begin to identify and categorize employers and try to identify insurance coverage for the various groups.
(e) Mandatory versus Voluntary Coverage
(f) Continuum of Options from Partial to Comprehensive Parity
(g) Analysis of Actuarial Data, including Alaska-specific Information
(h) Consideration of Public Input
(i) Review/Approval of Final Report – Steve recommended a time line that calls for completion of a draft report by December 31.  The working draft would be distributed to Task Force members during the third week of December.  Upon their direction, the contractor would then distribute the draft for public comment.  The Committee would receive such comment in written, oral, or testimony format (mid-January meeting).  Comments from the all of the relevant groups and the Task Force would then be integrated into the report and the final edition distributed.
(j) Development of any Proposed Legislation
(k) Others – Walter indicated that he had added this to ensure that there were no other major issues not included.  With the short time available for the completion of work, it will be critical to have the relevant issues identified at the beginning.
7. Options for Public Input.  The concept of public testimony at the next face-to-face meeting was approved.  Walter and Steve will make arrangements.
8. Determination of Future Meetings:
(a) October 26, 1998, 9:30 am(Business Meeting and Public Testimony)
(b) November 24, 1998, Time TBA
(c) January 13, 1999, Time TBA
(d) Teleconference late December; date to be announced
9. Next Meeting Agenda; Details.  Walter suggested that he and Steve work on meeting details and agenda.  The Task Force agreed with this approach.
10. Adjournment.  The meeting was adjourned at 12:50 pm.
Respectfully Submitted



 The Parity Task Force on Mental Health Insurance Committee meets

August 19, 1998 (Wednesday) from 10 am. to 4:30 pm.
at the API third floor big meeting room, Anchorage for the first time.

News Release July 1st 1998

The Parity Task Force on Mental Health

This nine-member task force will examine the issue of parity in health insurance policies.  The task force will study aproaches taken by other states and will make recommendations to the Legislature on how to increase parity between mental and physical illnesses.  It will be funded through the Mental Health Trust, which has allocated $50,000 to the task force and will not require any state general funds.

Legislative members include Senators John Torgerson and Johnny Ellis, and Representatives Gary Davis and Tom Brice.  Co-Chairs of the task force are Representative Gary Davis and Senator John Togerson.

Public sector members are Cynthia Dodge ( Anchorage Psychologist ), Jo Heusisen ( Insurance Broker ), Katsumi Kenaston ( Consumer ), Marianne Burke ( Director of Division of Insurance )

The Mental Health Board rep.  Pat Murphy
The Alcoholism and Drug Abuse Board.  Loren Jones
Commissioner's designee  Elmer A. Lindstrom
Special Assistant to the Commissioner

Note:  Walter Majoros is preparing to hire an office staff person and the location of the office and other details are unknown yet.

Establishing the Alaska Task Force on Parity for Mental Health.

By Tanya Iden, Legilslative Assistant to Representative Allen Kemplen

On April 25, 1997 Senate Concurrent Resolution 14 was introduced in the Alaska
State Legislature.  SCR 14 establishes the Alaska Task Force on Parity for
Mental Health.  The resolution was sponsored by the Senate Health, Education,
and Social Service Committee whose members are Senator Wilken (Chair), Senator
Leman (Vice Chair), Senator Green, Senator Ward, and Senator Ellis.

The bill was first referred to two Senate Committees - the Senate Health,
Education and Social Service Committee and the Senate Finance Committee.  On
February 17, 1998 SCR 14 passed the Senate HESS Committee and passed the Finance
Committee on March 20, 1998.  On March 23, 1998 the Senate voted unanimously in
favor of the Resolution.  SCR 14 was then transferred to the House of
Representatives where it was referred to the House Rules Committee.  On April 8,
1998 the Resolution passed out of the House Rules Committee.  The House of
Representatives voted unanimously in favor of SCR 14 on April 24, 1998 and the
Senate concurred with the bill on April 27, 1998.

SCR 14 was permanently filed as a legislative resolve on May 8, 1998.

Now the task at hand is for the President of the Senate and the Speaker of the
House to appoint members to the board.  Senate President Miller must appoint two
members of the Senate and Speaker Phillips must appoint two members of the House
of Representatives.  Together they also appoint two members representing the
insurance industry and two members representing mental health consumers and
community-based mental health providers.  In addition, the Alaska Mental Health
Board appoints a member to represent them, the Commissioner of the Department of
Health and Social Services must have a designee, and a representative of the
state Advisory Board on Alcoholism and Drug Abuse must be chosen.

The Task Force's first job is to define the following terms: mental disorders,
mental illness, serious mental illness, mental injury, and mental health
consumers. Once this duty is completed the members will study:
    1. Differential tretament in health insurance coverage between a person with
a mental disorder and a person with a physical disorder.
    2. Costs of mental health coverage in relation to other health care
insurance, with special emphasis on parity, and the extent of such coverage,
including deductables and co-payments, disorders and conditions to be covered,
and other pertinent issues.
    3. Ways to define and quantify unmet mental health needs in the state and
recommending meaningful ways to measure th efficacy of treatment of mental
health needs by analyzing possible outcome data collection measures.
    4. The positive and negative effects on metal health consumers if parity for
mental health coverage is mandated in Alaska.
    5. The feasibility fo implementing any recommendations of the task force
through legislation.
    6. The effect of the September 30, 2001, sunset date for the Mental Health
Parity Act of 1996 on the above mentioned issues.

The Alaska Task Force on parity for Mental Health shall provide a report to the
Legislature and the Governor by January 1, 1999 and the Task Force is terminated
on February 28, 1999.

Fifteen other states have established laws addressing mental health parity in
insurance practices.  The Task Force is the first step to enacting permanent
legislation concerning mental health parity.  Mental health consumers should
follow the activities of the Task Force by requesting agendas and minutes from
meetings.  The Task Force may  conduct public hearings to receive testimony
about issues relative to parity for mental health.

A staff person has not been hired yet, but once the Task Force is up and running
the staff person for the task force would be the appropriate person to contact
regarding information on meetings and any plans of action.  I'll keep you