FSAM NEWS

Dear Friends and Colleagues:
As your President I have set myself two simple but, nevertheless, challenging goals:

1. to improve the communication with our members.
2. to assist and support the independent practice of addiction medicine.

COMMUNICATION:
• I can be reached 24/7 via cell phone (305) 940-8717, or via e-mail at info@miamihealth.com, or via http://twitter.com/dadedoc.
• I am willing to travel to your local hospital to talk about ASAM, FSAM and the practice of addiction medicine.
• I am available for CME programs or can support you in developing educational outreach programs.

PRACTICE SUPPORT:

• As a member of the Medical Specialty Action Group(MSAG) I participated in the formation of the American Board of Addiction Medicine. The Board is now an independent entity and held is first meeting in April 2008. The formation of ABAM is an important milestone in the recognition of Addiction Medicine as a medical specialty. For more information see http://www.asam.org/CMS/images/PDF/AboutASAM/2008_Number-2_ABAM%20Issue.pdf .
• Parity Legislation: On October 3, 2008, President Bush signed HR 1424 into law. This bill, commonly known as the Wall Street "bailout bill" included a previously approved tax extenders bill as well as the compromise parity legislation. The Parity provisions contained is also known as Section 511:Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. It amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to require a group health plan that provides both medical and surgical benefits and mental health or substance use disorder benefits to ensure that: (1) the financial requirements, such as deductibles and copayments, applicable to such mental health or substance use disorder benefits are no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits covered by the plan; (2) there are no separate cost sharing requirements that are applicable only with respect to mental health or substance use disorder benefits; (3) the treatment limitations applicable to such mental health or substance use disorder benefits are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan; and (4) there are no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits.
• Requires the criteria for medical necessity determinations and the reason for any denial of reimbursement or payment for services made under the plan with respect to mental health or substance use disorder benefits to be made available by the plan administrator.
• Requires the plan to provide out-of network coverage for mental health or substance use disorder benefits if the plan provides coverage for medical or surgical benefits provided by out-of network providers.
• Exempts from the requirements of this Act a group health plan if the application of this Act results in an increase for the plan year of the actual total costs of coverage with respect to medical and surgical benefits and mental health and substance use disorder benefits by an amount that exceeds 2% for the first plan year and 1% for each subsequent plan year. Requires determinations as to increases in actual costs under a plan to be made and certified by a qualified and licensed actuary.
• Requires determinations for such an exemption to be made after such plan has complied with this Act for the first six months of the plan year.
• Sets forth requirements for notifications of exemptions under this Act, including notification of the Secretary of Health and Human Services, the appropriate state agencies, and participants and beneficiaries in the plan.
• Authorizes the Secretary and the appropriate state agency to audit the books and records of a group health plan relating to an exemption.
• Directs the Secretary to: (1) report to the appropriate congressional committees on compliance of group health plans with the requirements of this Act; and (2) publish guidance and information concerning the requirements of this Act and provide assistance concerning such requirements and the continued operation of applicable state law.
• Requires the Comptroller General to report to Congress on the specific rates, patterns, and trends in coverage and exclusion of specific mental health and substance use disorder diagnoses by health plans and health insurance.Most plans will begin implementing the new requirements in January 2010. This act represents a milestone in our struggle for parity and we need to closely monitor its implementation.

Please be advised that ASAM allocated significant financial resources to accomplish these two important goals: ABAM formation, Parity Bill.

Therefore, the ASAM Board decided to increase the membership dues to $390 for regular membership. This increase may be met with criticism but please rest assured that each and every dollar will be used to expand and strengthen our organization.

I look forward to your comments and please join our organization or renew your membership.

I also hope that I can count on your support for my candidacy as Region X Regional Director. You should have received your ballot already and please vote either via paper ballot or online.

Looking forward speaking with you soon.

Yours truly,
Bernd Wollschlaeger,MD,FAAFP,FASAM
President,Florida Society of Addiction Medicine
President, Dade County Medical Association