Access to High Quality MS Healthcare Principles

Principle 1 is realized when:

• People with MS have the information and resources they need to make informed decisions and advocate for their healthcare needs.
• People with MS and their healthcare providers have meaningful discussions to understand individual goals, needs and preferences and determine optimal treatments and strategies including wellness.
• The cost of healthcare services and treatment and what insurance plans cover are transparent, understandable and publicly available.
• People with MS are able to access information that describes the transactions and relationships amongst the organizations delivering healthcare.
• The effectiveness of healthcare services and treatments is known and understandable.

Principle 2 is realized when:

• Benefits are comprehensive and include appropriate services, medicines, treatments, equipment, supplies and assistive technology.
• Rehabilitation and wellness services, including complementary and alternative approaches, are available to maintain optimal health and improve quality of life.
• A diverse range of healthcare providers with the experience and expertise to treat and manage the symptoms and complexities of MS, including out-of-network providers when medically appropriate, are available. 
• Price and increases in prices are not barriers to accessing the optimal MS treatment for individual needs.
• Care is coordinated amongst all healthcare providers treating the person with MS.

Principle 3 is realized when:

• A full range of FDA -approved MS disease modifying therapies is covered including expenses associated with monitoring and delivery.
• Treatments that are effective for managing symptoms are covered whether they are FDA-approved for MS or used as an off-label treatment for MS.
• Insurance coverage is available for wellness-focused strategies including complementary and alternative approaches that have demonstrated benefit.
• Insurance appeals processes are standardized, easily navigated, and resolved in a timely manner with explained rationale.
• Care and treatment are continuous and uninterrupted during changes in insurance coverage, plan design and health provider networks.

Principle 4 is realized when:

• Healthcare providers have information to aid in early symptom recognition, diagnosis and treatment, in consultation with MS specialists when necessary.
• Healthcare providers caring for people with MS have the most up-to-date information to competently manage the complexity of MS.
• Healthcare providers meaningfully discuss wellness interventions including complementary and alternative approaches with their patients.
• Reimbursements for healthcare providers reflect the expertise and time necessary to meet the complex needs of people with MS.

including but not limited to disease progression, level of disability, geographic location, socioeconomic status, gender, sexual orientation, race/ethnicity, cultural background, age and care setting (home- and community-based or residential).

Principle 5 is realized when:

• Innovative tools and technology bridge geographic, linguistic and health literacy gaps and enhance access for people with severe physical and cognitive limitations.
• People with physical disabilities obtain care in healthcare settings with accessible equipment, exam tables, assistive technology and other necessary assistance at no additional cost and with the support of their insurer when needed.
• Healthcare services and providers deliver culturally competent care and meet the linguistic needs of individuals from diverse backgrounds.

(including assistive technology)

Principle 6 is realized when:

• People with MS can choose from the full range of age appropriate and affordable home-based, community-based and facility-based health and social service options to meet individual needs and preferences.
• Family caregivers have adequate financial, emotional and practical supports including care management, counseling, training and respite care.
• People with MS access the medical equipment and assistive technology that maintains each person’s highest level of functioning and independence.
• People with MS and their families can access a wide range of financial options and strategies to plan for the potential challenges of a long-term and costly chronic illness.