Complying With the Mental Health Parity and Addiction Equity Act

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Publication Details

  • Pub Code: BMHP-11WEB
  • Pages: 138
  • ISBN: 1-933801-66-2
  • Copyright 2010

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Complying With the Mental Health Parity and Addiction Equity Act

Provides insight for health plans and plan sponsors into the Mental Health Parity and Addiction Equity Act’s legal requirements. Written by experienced health benefits attorneys John R. Hickman, Esq., and Laurie Kirkwood, Esq., of the law firm of Alston & Bird, LLP, the book provides hands-on guidance for making complicated benefit design decisions that comply with the parity requirements.

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Get practical, hands-on guidance in Complying With the Mental Health Parity and Addiction Equity Act

Complying With the Mental Health Parity and Addiction Equity Act provides insight into the act’s legal requirements and offers hands-on guidance for making required but complicated benefit design decisions.

Any insurer or employer that offers health benefits must now cover mental illnesses and substance-use disorders on the same terms and conditions as other illnesses. While this general requirement sounds quite simple, the details demand that a number of complex compliance decisions be made — and will force most employers to make at least some changes to their health benefits packages.

The provisions of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 — and the interim regulations issued in February 2010 — have tremendous implications for mental health providers, pharma companies and others, with their dramatic impact on health plan benefit designs and virtually every employer with 50 or more employees.

  • For health insurers, among the many major changes is the requirement to develop new ways of processing behavioral health claims, which before were typically not applied to a health plan’s deductible and out-of-pocket maximums.
  • For plan sponsors, parity will result in an increase in employer-paid coinsurance amounts, which could lead to substantially increased utilization of behavioral health services and pharmaceuticals, in turn producing potentially higher employer benefit costs.

Order Complying With the Mental Health Parity and Addiction Equity Act today to get practical guidance on complying with the law.

Table of Contents

Chapter 1: Introduction

  • Background
  • Overview of the MHPAEA
  • What Plans Are Subject to the Act?
  • Anti-Abuse Clause/Plan Aggregation Rule
  • Are Health Care FSAs and HRAs Subject to MHPAEA?
  • Exemptions
  • State Law Issues
  • Effective Date
  • Delayed Effective Date for Certain Collectively Bargained Plans

Chapter 2: Defining ‘Mental Health Benefits’ and ‘Substance-Use Disorder Benefits’

  • Autism and Other ‘Biologically Based’ Conditions
  • Interaction of the Act with State Law and Pre-emption

Chapter 3: Financial Requirements

  • Changes to Annual and Lifetime Limits under the 1996 MHPA
  • General Parity Requirement for Financial Requirements
  • What Is a Financial Requirement?

Chapter 4: Treatment Limitations

  • General Parity Requirement for Treatment Limitations
  • What Is a Treatment Limitation?
  • Is Excluding a Particular Condition or Treatment a ‘Treatment Limitation’?
  • Cumulative Quantitative Treatment Limitations
  • Nonquantitative Treatment Limitations
  • A Limited Exemption for EAPs?

Chapter 5: Measuring Benefits

  • General Parity Requirement
  • Six Classifications of Benefits
  • Potential Pitfalls
  • Applying the Parity Rules to the Classifications
  • Projecting Plan Payments
  • Special Rules for Deductibles, Out-of-Pocket Maximums, and ‘Zero’ Levels
  • ‘Substantially All’ Determinations
  • ‘Predominant’ Determinations
  • Combining Levels
  • Special Rule for Prescription Drug Benefits
  • Other Issues in Measuring Benefits

Chapter 6: Exemptions

  • The Small Employer Exception
  • The Small Plan Exception
  • Exceptions for Certain Benefits
  • Cost Exemption
  • Opt-Out for Non-Federal Governmental Self-Funded Plans

Chapter 7: Other Provisions and Issues Under MHPAEA

  • Availability of Plan Information
  • Union Plans
  • Enforcement
  • GAO Study
  • Comments on the Interim Regulations

Chapter 8: Compliance Roadmap

Appendix A: Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008

Appendix B: Interim Final Rules Under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Final Rule

Appendix C: CMS Model Exemption Election Letter and Model Notice to Enrollees

Appendix D: Request for Information Regarding the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008

Written By

John R. Hickman, Esq. is head of the Health Benefits Practice at Alston & Bird, LLP, where he leads several attorneys devoted exclusively to HIPAA privacy, flexible benefits and other health and welfare benefit issues. He has been a pioneer in the consumer directed health care arena and has worked closely with health plans, financial institutions, and employers with regard to such arrangements. Mr. Hickman has been listed in The Best Lawyers in America (Woodward/White) and Who’s Who Legal in the employee benefits area. He has lectured widely and published articles on HIPAA, ERISA litigation, cafeteria and health plan issues. Mr. Hickman is head of the Technical Advisory Committee and is on the board of the Employers Council on Flexible Compensation. He is an adjunct professor of law at Emory University School of Law.

Laurie Kirkwood, Esq. is an associate in the Atlanta office of Alston & Bird, LLP, where her practice focuses exclusively on health benefit issues affecting health plans and employer plan sponsors. She is a frequent author and speaker on health benefit issues.

Written For

Financial managers, medical officers, clinical services directors, compliance officers, product developers, and marketing directors at health plans and large employer purchasers.

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Complying With the Mental Health Parity and Addiction Equity Act

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$179.00

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