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Department of Labor releases FAQs on mental health parity compliance

Posted on May 10, 2012 | No Comments

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The Department of Labor’s Employee Benefits Security Administration  published a set of frequently asked questions (FAQs) regarding implementation of the Mental Health Parity and Addiction Equity Act of 2008.

Amongst other topics, the FAQs address whether a health plan can define mental health coverage as solely consisting of inpatient care benefits. The Department of Labor said that plans are not permitted to define mental health coverage as such if they provide benefits under one of the following six classifications of benefits that are subject to the law:

  • inpatient, in-network;
  • inpatient, out-of-network;
  • outpatient, in-network;
  • outpatient, out-of-network;
  • emergency care; and
  • prescription drugs.

Other topics include oversight of Mental Health Parity and Addiction Equity Act (MHPAEA) implementation; the law’s interaction with state mandates; which plans are exempt from MHPAEA; and what the Department of Labor, the Treasury Department, and the Department of Health and Human Services are doing to promote compliance.

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The Department of Health and Human Services (HHS), Department of Labor (DoL), and the Department of the Treasury (DoT) released the joint final rule implementing the Mental Health Parity and Addiction Equity Act of 2008. Under this law, insurers that offer coverage for mental health services are expected to treat mental health equitably, meaning cost-sharing and limits for mental health services should be comparable to that of physical health services. Several other specific provisions addressed in this rule include:
  • Parity for intermediate care offered in residential or outpatient settings and all plan standards (i.e. network adequacy and geographic limits);
  • Clarifying transparency expectations for insurers to remain compliant with the law; and
  • Eliminating provisions that enabled insurers to make exceptions for parity requirements for certain benefits offered.
The law was passed in 2008, and an interim final rule was issued in January 2010. The Centers for Medicare and Medicaid Services (CMS) also published an FAQ on today's rule.
The Centers for Medicare & Medicaid Services (CMS) today releaseda mental health guidance to the states clarifying requirements under the Mental Health Parity and Addiction Equity Act of 2008. Specifically, the letter address the applicability of the requirements under the parity law to Medicaid non-managed care benchmark and benchmark-equivalent plans as described in section 1937 of the Social Security Act, the Children’s Health Insurance Programs (CHIP) under title XXI of the Act, and Medicaid managed care programs as described in section 1932 of the Act.
On December 16, 2011, the HHS Center for Consumer Information and Insurance Oversight (CCIIO) released an Essential Health Benefits Bulletin, whose purpose is to “provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits under section 1302 of the Affordable Care Act.” Comments on the Bulletin can be sent directly to EssentialHealthBenefits@cms.hhs.gov and will be accepted until January 31, 2011
According to a set of frequently asked questions (FAQs) recently released by the Departments of Health and Human Services (HHS), Treasury (DOT), and Labor (DOL), the final rule under an Affordable Care Act (ACA) provision, which requires health care insurers and group health plans to make available to consumers a standardized summary of the benefits and coverage for each plan they offer, will be released "as soon as possible." The FAQs pertain to implementation of ACA market reform provisions and mental health parity requirements. Until this final rule is released, plans are not required to comply with the proposed rule's provisions. The ACA requires plans to provide consumers with a standardized form containing definitions of benefits and information on coverage. Along with the benefits and coverage summary, the departments also included several FAQs addressing the implementation of the Mental Health Parity and Addiction Equity Act of 2008, which mandates equal treatment for medical and surgical care and mental health and substance use disorder care in areas such as out-of-pocket costs and benefit limits and practices.
Recently, Sara Rosenbaum, the Hirsh Professor of Health Law and Policy at the GW Department of Health Policy, had an opportunity to interview Phyllis Borzi, the federal official in charge of overseeing the Employee Benefits Security Administration (EBSA), for Health Reform GPS. EBSA is an agency of the United States Department of Labor responsible for administering, regulating and enforcing the provisions of Title I of the Employee Retirement Income Security Act of 1974 (ERISA), and the agency is playing an important role in the implementation of the Affordable Care Act....
In February 2012, CMS issued a supplemental document entitled Frequently Asked Questions on Essential Health Benefits Bulletin. This supplement to the December 16th Bulletin provides answers to 22 questions arising from the December 16th Bulletin itself. Highlights are as follows:
On December 16, 2011, the HHS Center for Consumer Information and Insurance Oversight (CCIIO) released an Essential Health Benefits Bulletin, whose purpose is to “provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits under section 1302 of the Affordable Care Act.” Comments on the Bulletin can be sent directly to EssentialHealthBenefits@cms.hhs.gov and will be accepted until January 31, 2011
Under the Affordable Care Act (ACA) beginning January 1, 2014, state insurance Exchanges become operational and comprehensive insurance market reforms take effect. One of the most significant market reforms is the requirement that all health insurance plans sold in the individual and small group (100 employees or fewer) markets – whether sold outside or inside state insurance Exchanges – cover “essential health benefits” (EHBs). The definition of EHBs also will apply to Medicaid “benchmark” plans, the specified coverage standard for individuals made newly eligible by the ACA’s Medicaid expansions.
The Affordable Care Act (ACA) requires that all health insurance issuers offering products in the individual and small-group markets, including both the state Exchange market as well as the non-Exchange market, provide coverage of certain “essential health benefits.” An earlier Implementation Brief explored the concept of “essential health benefits.” This Brief summarizes a new U.S. Department of Labor (DOL) report on benefits covered in a “typical” employer plan and identifies key implementation issues for the federal Department of Health and Human Services (HHS).
Bringing down the overall cost of health care while improving its quality for all Americans represents one of the central goals of health reform. Although reducing the number of people without health insurance will provide relief by curtailing much of the estimated $50 billion in annual cost-shifting onto the insured, the longer term challenges are more complex, because they involve structural change in how health care is organized, delivered, and paid for. Specifically, improving health care quality while reducing costs means doing two things simultaneously: moving away from a fragmented system oriented toward what has been termed a “piecework” approach to health care; and introducing new approaches that reward greater clinical integration and efficiencies aimed at creating equally effective but lower-cost care. To achieve these results, the concept of “value-based purchasing” has received increased attention.
The Institute of Medicine's (IOM) Committee on the Determination of Essential Health Benefits held its first meeting this week to discuss essential benefits under the Affordable Care Act (ACA). The IOM is charged with making recommendations to the Secretary of HHS on the criteria for determining what constitutes essential health benefits for insurance plans sold in exchanges. For more information on essential benefits, click here.