Tag: Mental Health Parity

COVID-19

DOL Issues Additional Guidance on COVID-19 Testing Coverage

The exact scope of the health coverage mandate for COVID-testing was clarified in a new round of regulatory guidance from the U.S. Department of Labor (DOL). The frequently asked questions (FAQs) also address notice requirements, telehealth coverage, and the interaction of COVID-19 emergency relief with existing benefits laws.

U.S. Departments Release Guidance on ACA Implementation, Mental Health Parity

By Benjamin J. Conley, JD In late October, the Internal Revenue Service (IRS), U.S. Department of Labor (DOL), and the U.S. Department of Health and Human Services (HHS) released a series of informal frequently asked questions (FAQs) addressing various unanswered questions under the Affordable Care Act’s (ACA’s) preventive service mandate, the Mental Health Parity, and […]

Reform Agencies Warn: Don’t Unduly Restrict Preventive Care

Plans may not impose cost-sharing on out-of-network services unless in-network providers are available and the plan member goes out of network in spite of that, federal agencies  noted in FAQs on the ACA Part XXIX. But if network provider directories fail to list providers as offering the service in question, then plan members do not […]

Devil Is in Details of Final Mental Health Parity Rules

Pre-authorization procedures, plan disclosures and geographical restrictions are just a few features  group health plans will need to re-examine by the time the recently finalized mental health parity rules take effect. For calendar-year plans, this means Jan. 1, 2015 — less than a year away. The interaction of the Mental Health Parity and Addiction Equity […]

TPA May Not Be Sued for MHPAEA Violations, Court Rules

A third-party claims administrator may not be sued for violating the Mental Health Parity and Addiction Equity Act because the law by its terms applies only to group health plans and their insurers, a federal district court ruled. Related ERISA claims against the TPA were also dismissed because the company was not the “plan administrator” […]

Mental Health Parity Rules Remove ‘Clinically Appropriate’ Exemption

Final mental health parity rules issued Nov. 8 make several changes to the prior, interim version. The exemption for “clinically appropriate standards of care” was eliminated because regulators decided it was confusing and subject to abuse, and the rules’ application to “intermediate” coverage levels was clarified in response to uncertainty about how the interim rules’ […]

DOL Debuts MHPAEA Web Page, Adds FAQs

The U.S. Department of Labor has collected its rules, guidance and other materials on the Mental Health Parity and Addiction Equity Act into a new MHPAEA Web page. The materials on this page include a new set of frequently asked questions on “understanding implementation” of MHPAEA, which when enacted in 2008 substantially beefed up HIPAA’s […]

DOL Clarifies Mental Health Parity’s Effect on Pre-Authorization

The effect of the Mental Health Parity and Addiction Equity Act (MHPAEA) on prior authorization practices and other “nonquantitative treatment limitations” was clarified Nov. 17 in guidance from the U.S. Department of Labor (DOL). The MHPAEA interim final rules issued in February 2010 imposed a detailed numerical formula for determining whether quantitative limits such as copayments […]