The future of medical formula/food coverage is at risk.
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geminigirl1979
Posts: 38 Member
Advocate for Continued Medical Foods Coverage!!!!! Please read the following message, originally sent by the National PKU Alliance (npkua.org), and take action by sending your e-mail (the address is below) BY THANKSGIVING to encourage the Department of Health and Human Services to include medical food and formula as an ESSENTIAL HEALTH BENEFIT for PKU and Allied Disorders. Please feel free to forward this on to anyone and everyone you know!
The future of medical food coverage (formula and foods modified to be low in protein) is now at risk.
Last month, the Institute of Medicine released its report on essential health benefits under the Affordable Care Act. The report lists what essential health benefits will become standard in the insurance exchanges that must be offered to individuals and small groups in state-based purchasing exchanges and the existing insurance coverage market beginning in 2014. Many Americans will receive their health insurance through these new exchanges and several large insurers will also follow these rules for ease of administration.
The report does NOT include coverage for formula or for foods modified to be low in protein to treat PKU and other inborn errors of metabolism. Instead, the Institute of Medicine recommended in the report that the Department of Health and Human Services further evaluate coverage for nutritional supplements and formulas needed for the treatment of inborn errors since coverage is often excluded unless there is a state mandate.
If medical foods are not included in the final essential health benefit package, states that want to offer medical foods coverage for PKU in the insurance exchanges will have to pay for this additional cost - even if a state law requiring coverage is currently in place. This increase in cost has to be paid by the state - it cannot be passed on to beneficiaries through higher premiums. Since state budgets are already tight, the current state mandates and programs in 38 states are also now in jeopardy.
How You Can Help Now: The NPKUA and our partner organizations are currently offering public comments at 10 the Department of Health and Human Services (HHS) regional listening sessions that are being held around the country before Thanksgiving.
We now need you to follow up on these sessions and submit written comments to HHS asking them to include medical foods for the treatment of PKU and similar inborn errors of metabolism as an essential health benefit under the chronic disease management category.
Emails should be sent to: externalaffairs@hhs.gov before the final essential health benefit package is written.
Write Your Email Today! The following talking points can assist you with writing your email, but please do not feel limited by these. The more variety of messages sent, the more impact we can make.
-Let them know who you are and your relation to PKU.
-Newborn screening is a mandatory public health program. Failing to include coverage for medical foods discriminates against people with PKU based on their disability. Medical foods are as important to a person with PKU as insulin is to a person with diabetes.
-It is easy to balance coverage with cost when treating PKU and other inborn errors of metabolism. Not covering medical foods is catastrophic and fatal. Failing to include coverage for PKU and other inborn errors of metabolism will lead to damaged babies, severe disability and the death of many children.
-Inborn errors are rare disorders. The cost to include coverage for their treatment is minimal. Don't let these children and adults fall through the cracks. The cost of coverage is small, but the cost of not acting is enormous.
-Coverage for treatment of PKU means the difference between leading a healthy and productive life and being institutionalized. Treating PKU saves the government money.
-PKU is different than other disorders where the majority of states have mandated benefits through state law. There are decades of proven evidence-based success in treating people with PKU with medical foods.
-Not treating is catastrophic. Not including coverage for PKU and other inborn errors of metabolism will cause many families to lose coverage because states will not cover the cost either because of politics or their bad economies. This will lead to damaged babies, severe disability and sick children.
Take Immediate Action! There is limited time to advocate for medical foods to be included as an essential health benefit.
Send Your Email TODAY: externalaffairs@hhs.gov
Thank you for taking the time to send your message to HHS. Your active role as part of the PKU community will help adults and children with PKU get and maintain coverage for medical foods!
The future of medical food coverage (formula and foods modified to be low in protein) is now at risk.
Last month, the Institute of Medicine released its report on essential health benefits under the Affordable Care Act. The report lists what essential health benefits will become standard in the insurance exchanges that must be offered to individuals and small groups in state-based purchasing exchanges and the existing insurance coverage market beginning in 2014. Many Americans will receive their health insurance through these new exchanges and several large insurers will also follow these rules for ease of administration.
The report does NOT include coverage for formula or for foods modified to be low in protein to treat PKU and other inborn errors of metabolism. Instead, the Institute of Medicine recommended in the report that the Department of Health and Human Services further evaluate coverage for nutritional supplements and formulas needed for the treatment of inborn errors since coverage is often excluded unless there is a state mandate.
If medical foods are not included in the final essential health benefit package, states that want to offer medical foods coverage for PKU in the insurance exchanges will have to pay for this additional cost - even if a state law requiring coverage is currently in place. This increase in cost has to be paid by the state - it cannot be passed on to beneficiaries through higher premiums. Since state budgets are already tight, the current state mandates and programs in 38 states are also now in jeopardy.
How You Can Help Now: The NPKUA and our partner organizations are currently offering public comments at 10 the Department of Health and Human Services (HHS) regional listening sessions that are being held around the country before Thanksgiving.
We now need you to follow up on these sessions and submit written comments to HHS asking them to include medical foods for the treatment of PKU and similar inborn errors of metabolism as an essential health benefit under the chronic disease management category.
Emails should be sent to: externalaffairs@hhs.gov before the final essential health benefit package is written.
Write Your Email Today! The following talking points can assist you with writing your email, but please do not feel limited by these. The more variety of messages sent, the more impact we can make.
-Let them know who you are and your relation to PKU.
-Newborn screening is a mandatory public health program. Failing to include coverage for medical foods discriminates against people with PKU based on their disability. Medical foods are as important to a person with PKU as insulin is to a person with diabetes.
-It is easy to balance coverage with cost when treating PKU and other inborn errors of metabolism. Not covering medical foods is catastrophic and fatal. Failing to include coverage for PKU and other inborn errors of metabolism will lead to damaged babies, severe disability and the death of many children.
-Inborn errors are rare disorders. The cost to include coverage for their treatment is minimal. Don't let these children and adults fall through the cracks. The cost of coverage is small, but the cost of not acting is enormous.
-Coverage for treatment of PKU means the difference between leading a healthy and productive life and being institutionalized. Treating PKU saves the government money.
-PKU is different than other disorders where the majority of states have mandated benefits through state law. There are decades of proven evidence-based success in treating people with PKU with medical foods.
-Not treating is catastrophic. Not including coverage for PKU and other inborn errors of metabolism will cause many families to lose coverage because states will not cover the cost either because of politics or their bad economies. This will lead to damaged babies, severe disability and sick children.
Take Immediate Action! There is limited time to advocate for medical foods to be included as an essential health benefit.
Send Your Email TODAY: externalaffairs@hhs.gov
Thank you for taking the time to send your message to HHS. Your active role as part of the PKU community will help adults and children with PKU get and maintain coverage for medical foods!
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