cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
As illustrated here, ERISA did not preempt the Washington Mental Health Parity Act.
Even though it correctly applied an insured ERISA plan’s coverage restrictions on neurodevelopmental therapy for children over six years old, the administrator’s refusal to pay a 10-year-old dependent’s mental health treatment violated a state law that bound insurers and HMOs. (more…)
Category: ERISA, Health Care Legislation, Mental Health Parity, PPACA, Preemption, Supreme Court, Washington |
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cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
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). (more…)
Category: DOL, Mental Health Parity |
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cmonfils | December 22, 2011
The Department of Labor released a set of Frequently Asked Questions (FAQs) responding to questions raised regarding how the new parity requirements apply to nonquantitative treatment limitations, such as medical management standards, formulary designs, standards for provider admission to the network, and methods to determine reasonable and customary fees.
Category: Mental Health Parity |
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cmonfils | December 2, 2011
The trio of federal agencies charged with interpreting and enforcing the Affordable Care Act and the Mental Health Parity and Addiction Equity Act have addressed some of the most significant questions arising from these laws.
In a set of Answers to Frequently Asked Questions, the U.S. Departments of Treasury, Labor, and Health and Human Services have intimated that the looming ACA deadline for the production and distribution of summaries of benefits and coverage will be extended. The FAQs also provide guidance on the qualitative requirements under MHPAEA.
http://ebn.benefitnews.com/eletter/profile/14/2650.html
Category: HHS, Mental Health Parity |
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cmonfils | December 2, 2011
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).
Category: DOL, Mental Health Parity |
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cmonfils | November 30, 2011
On November 17, 2011, the Department of Labor (DOL) issued responses to frequently asked questions (FAQs) on health care reform and the Mental Health Parity and Addiction Equity Act of 2008. The FAQs provide guidance on the health plan benefits summary requirement under health care reform, and they also clarify the permissible nonquantitative limitations that health plans may apply to mental health and substance abuse benefits.
Category: DOL, Health Care Legislation, Mental Health Parity |
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cmonfils | November 30, 2011
Set out below are additional Frequently Asked Questions (FAQs) regarding implementation of the market reform provisions of the Affordable Care Act, as well as FAQs regarding implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). These FAQs have been prepared jointly by the Departments of Health and Human Services (HHS), Labor and the Treasury (the Departments). Like previously issued FAQs (available at www.dol.gov/ebsa/healthreform/), these FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended.
The Departments anticipate issuing further responses to questions and issuing other guidance in the future. We hope these publications will provide additional clarity and assistance.
Category: Health Care Legislation, Health Insurance, Mental Health Parity |
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cmonfils | November 20, 2011
Employer’s Guide to Self-Insuring Health Benefits
Thompson Publishing November 2011 Vol. 19, No. 2
The 9th U.S. Circuit Court of Appeals ordered Blue Shield of California, the plan administrator of an insured ERISA plan, to cover a residential stay for psychological treatment despite plan terms excluding residential stays of any kind. The court even found that Blue Shield gave its plan document a sound reading. California’s Mental Health Parity Act provides coverage for “medically necessary” diagnosis and treatment of “severe mental illnesses,” whether or not it involves a residential stay. The court rejected Blue Shield’s attempt to circumscribe the Parity Act to services listed in that Act and matching the Knox-Keene Act. Then the court held Blue Shield forfeited its right to argue against medical necessity in court because it had not done so in the administrative stage. (more…)
Category: 9th, California, ERISA, Health Insurance, Mental Health Parity |
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cmonfils | August 30, 2011
August 26, 2011 | 4:39 pm
A case to watch as residential treatment was excluded. Obviously, this is applying state parity on top of federal parity (as there are not 9 conditions mandated for coverage under federal parity). Just another reason to be self-funded!
From the LA Times… (more…)
Category: Mental Health Parity |
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cmonfils | April 1, 2011
www.hr.cch.com
3/28/11
from Spencer’s Benefits Reports: A two-month stay at a residential treatment facility for cocaine addition did not qualify for plan coverage because an acute level of care was not needed after two days, the Sixth Circuit Court of Appeals ruled in upholding the plan’s denial of benefits (Meredith Solomon v. Medical Mutual of Ohio, No. 09-4152). (more…)
Category: Mental Health Parity, Ohio, Plan Language |
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cmonfils | March 10, 2011
www.healthplanlaw.com March 4, 2011 •
“ . . . [I]n order for Principal to reasonably deny S.W.’s hospital charges, substantial evidence had to support its determination that the primary focus of her hospitalization was mental health treatment, i.e., treatment designed to alter her behavior. While there is certainly evidence that mental health treatment was one focus of S.W.’s hospitalization, we conclude there is insufficient evidence to support the determination that S.W.’s mental health was the primary focus of the hospitalization.“ (more…)
Category: 8th, Mental Health Parity |
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cmonfils | February 2, 2011
www.hreonline.com By Carol Harnett
With their actuaries projecting a significant increase in healthcare costs to offer mental-health and substance-abuse coverage, the Screen Actors Guild dropped mental-health coverage for its members. Is that a harbinger of things to come?
I began a self-imposed holiday break on Dec. 23, 2010. I committed to family and friends that — for one week — I would stop working. No voicemail, no e-mail, no Twitter and no business-related reading. (more…)
Category: Mental Health Parity |
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cmonfils | February 2, 2011
www.hreonline.com By Kristen B. Frasch
New regulations that prohibit large health plans from setting higher co-payments or limiting doctor visits for mental-health care are leading some organizations to drop mental-health benefits altogether. That’s a “very, very” bad idea, experts say.
With the new requirements of the Mental Health Parity and Addiction Equity Act going into effect at the start of 2011, many organizations are now making adjustments to comply and to avoid prohibitive cost increases. (more…)
Category: Mental Health Parity |
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cmonfils | January 17, 2011
www.hreonline.com
By Kristen B. Frasch
New regulations that prohibit large health plans from setting higher co-payments or limiting doctor visits for mental-health care are leading some organizations to drop mental-health benefits altogether. That’s a “very, very” bad idea, experts say.
With the new requirements of the Mental Health Parity and Addiction Equity Act going into effect at the start of 2011, many organizations are now making adjustments to comply and to avoid prohibitive cost increases. (more…)
Category: Mental Health Parity |
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cmonfils | January 12, 2011
www.hr.cch.com
CCH® BENEFITS — 01/06/11
from Spencer’s Benefits Reports: A health care plan that specifically excludes coverage in residential treatment programs is not compelled to provide such coverage when a state law does not include it in the list of limits establishing parity among mental health conditions and physical health conditions. In Douglas S., Ann C.S. and Laura S. v. Altius Health Plans (No. 09-4130, Nov. 5, 2010), the Tenth Circuit Court of Appeals applied Utah Law Sec. 31A-22-625 to the case because “Sec. 625 meets the two-pronged test of Kentucky Association of Health Plans, Inc. v. Miller, 538 U.S. 329 (2003), and is thus saved from ERISA preemption.” (more…)
Category: Mental Health Parity |
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