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DOL Gives a Peek at Non-quantitative Treatment Limitations

February 14, 2017

Authors

Chris Rylands and Serena Yee

DOL Gives a Peek at Non-quantitative Treatment Limitations

February 14, 2017

by: Chris Rylands and Serena Yee

Mental Health ScrabbleWhile on this day, most people focus on the heart, we’re going to spend a little time focusing on the head.  Under the Mental Health Parity and Addiction Equity Act (MHPAEA), health plans generally cannot impose more stringent “non-quantitative” treatment limitations on mental health and substance abuse benefits (we will use “mental health” for short) than they impose on medical/surgical benefits.  The point of the rule is to prevent plans from imposing standards (pre-approval/precertification or medical necessity, as two examples) that make it harder for participants to get coverage for mental health benefits than medical/surgical benefits. “Non-quantitative” has been synonymous with “undeterminable” and “unmeasurable”,  so to say that this is a “fuzzy” standard is an understatement.

However, we are not without some hints as to the Labor Department’s views on how

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Tobacco, Heroin, and Mental Health (Treatment, That Is)

November 16, 2016

Authors

Chris Rylands

Tobacco, Heroin, and Mental Health (Treatment, That Is)

November 16, 2016

by: Chris Rylands

CC000596In the latest round of ACA and Mental Health Parity FAQs (part 34, if you’re counting at home), the triumvirate agencies addressed tobacco cessation, medication assisted treatment for heroin (like methadone maintenance), and other mental health parity issues.

Big Tobacco.  The US Preventive Services Task Force (USPSTF) updated its recommendation regarding tobacco cessation on September 22, 2015. Under the Affordable Care Act preventive care rules, group health plans have to cover items and services under the recommendation without cost sharing for plan years that begin September 22, 2016.  For calendar year plans, that’s the plan year starting January 1, 2017.

The new recommendation requires detailed behavioral interventions.  It also describes the seven FDA-approved medications now available for treating tobacco use.  The question that the agencies are grappling with is how to

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New ACA, et. al. FAQs Cover Items From “Top” to “Bottom”

April 26, 2016

Authors

Chris Rylands

New ACA, et. al. FAQs Cover Items From “Top” to “Bottom”

April 26, 2016

by: Chris Rylands

Question Mark ManOn April 20, the “Big Three” agencies (DOL, Treasury/IRS, and HHS) released another set of FAQs (the 31st, for those of you counting at home). Consistent with earlier FAQs, the new FAQs cover a broad range of items under the Affordable Care Act, Mental Health Parity and Addiction Equity Act, and Women’s Health Cancer Rights Act. The authors are admittedly curious about how “Frequently” some of these questions are really asked, but we will deal with all of them in brief form below.

1. Bowel Preparation Medication – For those getting a colonoscopy, there is good news. (No, you still have to go.) But the ACA FAQs now say that medications prescribed by your doctor

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Scratch & Sniff the New Health Plan FAQs

November 12, 2015

Authors

Serena Yee and Lisa Van Fleet

Scratch & Sniff the New Health Plan FAQs

November 12, 2015

by: Serena Yee and Lisa Van Fleet

ACA Blue HighlightLast month the U.S. Departments of Labor, Health and Human Services and Treasury published FAQs offering a veritable potpourri of guidance addressing preventive services, wellness programs and mental health parity.  Some potpourris offer a pleasing aroma – other not so much.  Decide for yourself whether this potpourri of guidance is pleasing based on the following summary.

PREVENTIVE SERVICES – New guidance expands coverage obligations.

Non-grandfathered health plan must cover certain preventive services without the imposition of any cost sharing.

Lactation Counseling/Equipment. Among the preventive services that a non-grandfathered health plan must cover in-network without cost-sharing is comprehensive prenatal and postnatal lactation support, counseling, and equipment rental. The Departments provided the following clarifications with respect to such preventive service:

  • If participants do not have access to lactation counseling in-network, the plan
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Autism Spectrum Disorder and ABA Treatment – New Legal Theories Facing Self-Insured Plans?

May 29, 2014

Authors

benefitsbclp

Autism Spectrum Disorder and ABA Treatment – New Legal Theories Facing Self-Insured Plans?

May 29, 2014

by: benefitsbclp

492969231Federal law governing mental health benefits is giving rise to a new wave of lawsuits against self-insured ERISA welfare benefit plans.  Plan sponsors should carefully consider their current scope of coverage to avoid litigation risk and ensure fair benefits for participants.

ERISA and other governing federal laws historically have not required that plan sponsors or insurers provide any particular coverage or level of benefits.  Thus, plans and insurers could pick and choose what type of benefits and coverage to offer.

Even with the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (the “Parity Act”), plans and insurers were not required to offer any mental health benefits.  However, the 2008 Parity Act requires group health plans and health insurance issuers that offer mental

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Mental Health Parity Update – Final Regulations Incorporate Prior FAQS and Make Other Changes

November 20, 2013

Authors

benefitsbclp

Mental Health Parity Update – Final Regulations Incorporate Prior FAQS and Make Other Changes

November 20, 2013

by: benefitsbclp

More than five years after the initial adopting legislation was passed into law, the Departments of Treasury, Labor and Health and Human Services jointly issued final regulations implementing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended by ACA. MHPAEA amends certain provisions of the Public Health Service Act (PHSA), ERISA and the Internal Revenue Code in a manner designed to provide increased parity between mental health and substance use disorder benefits and medical/surgical benefits.

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Health Reform FAQs Part XII on Cost-Sharing Limits

February 27, 2013

Authors

Chris Rylands and Serena Yee

Health Reform FAQs Part XII on Cost-Sharing Limits

February 27, 2013

by: Chris Rylands and Serena Yee

The Department of Treasury/IRS, Department of Labor, and the Department of Health and Human Services (the “Departments”) recently issued its twelfth set of Frequently Asked Questions. As Kevin Knopf, Special Counsel at the U.S. Treasury Department, once observed, the FAQs are numbered using Roman numerals, “like all important things…such as the Superbowl.”  The latest FAQs (which, by number, correspond to the 1978 showdown between the Dallas Cowboys and Denver Broncos) address cost-sharing limitations and a slew of preventive services issues.  This post will address the cost-sharing limitations.

Cost-Sharing Limits Generally. Health care reform imposes two cost-sharing limitations on non-grandfathered group health plans for plan years beginning in 2014:

  • First, for any group health plan (including self-funded plans) the out-of-pocket maximum cannot exceed a specified dollar amount.  For plan years beginning in 2014, the maximum will equal the combined annual out-of-pocket and deductible limits that
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Newtown & Mental Health Parity

January 25, 2013

Authors

Chris Rylands

Newtown & Mental Health Parity

January 25, 2013

by: Chris Rylands

Last week, the White House released its plan for legal actions it will recommend to try and ensure that a tragedy like the one in Newtown does not recur (although the video from President Obama’s weekly address on this issue does not mention mental health services).  Much of the debate since that announcement has predictably been focused on the Second Amendment issues, but there was one benefits-related point buried near the end of the White House’s plan: finalizing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) regulations.  The plan says the regulations will be issued next month and the administration has already taken the step of advising Medicaid directors of the applicable ability of MHPAEA to their programs.

The interim final MHPAEA rules were issued in 2010 and since then, the DoL has issued some FAQs (here, here, here, and Read More

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