By Atlantic Information Services
Buy new: $179.00
First tagged by J. Johnson
Customer tags: compliance, parity, benefits, mental health, treatment limitations, healthcare, exemptions
Review & Description
Any insurer or employer that offers mental 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 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.
Complying With the Mental Health Parity and Addiction Equity Act is a softbound book from Atlantic Information Services, Inc. that provides insight into the Mental Health Parity and Addiction Equity Act s legal requirements and offers hands-on guidance for making required but complicated benefit design decisions.
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, pharmaceutical 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.
Table of Contents
Chapter 1: Introduction
* What Plans Are Subject to the Act?
* Anti-Abuse Clause/Plan Aggregation Rule
* Are Health Care FSAs & HRAs Subject to MHPAEA?
* Exemptions
* State Law Issues
* Delayed Effective Date for Certain Collectively Bargained Plans
Chapter 2: Defining Mental Health Benefits & Substance-Use Disorder Benefits
* Autism & Other Biologically Based Conditions
* Interaction of the Act with State Law & Pre-emption
Chapter 3: Financial Requirements
* Changes to Annual & Lifetime Limits under the 1996 MHPA
* General Parity Requirement for Financial Requirements
Chapter 4: Treatment Limitations
* General Parity Requirement for Treatment Limitations
* 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, & 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 & 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 & Pete Domenici Mental Health Parity & Addiction Equity Act of 2008
Appendix B: Interim Final Rules Under MHPAEA; Final Rule
Appendix C: CMS Model Exemption Election Letter & Model Notice to Enrollees
Appendix D: Request for Information Regarding MHPAEA
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