mental health parity and addiction equity act (mhpaea)
DESCRIPTION
Mental Health Parity and Addiction Equity Act (MHPAEA). Access to Tobacco Cessation Services May 19-20, 2014 Warren Ortland Staff Attorney Tobacco Control Legal Consortium. The Tobacco Control Legal Consortium. A national legal network supporting tobacco control policy change. . - PowerPoint PPT PresentationTRANSCRIPT
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Mental Health Parity and Addiction Equity Act
(MHPAEA)Access to Tobacco Cessation Services
May 19-20, 2014
Warren OrtlandStaff AttorneyTobacco Control Legal Consortium
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The Tobacco Control Legal Consortium
A national legal network supporting tobacco control policy change.
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Tobacco Law Centers
California
Minnesota
Michigan
Massachusetts
Maryland
New York
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Who We Serve:
• Public health advocacy organizations and community coalitions
• Public health officials
• Elected officials
• City and county attorneys
• Private attorneys and individual citizens
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What We Do:
• Policy development
• Litigation support
• Legal research, analysis, and interpretation
• Education and training
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Paul Wellstone & Pete Domenici Mental Health Parity and Addiction Equity Act
of 2008 (MHPAEA)
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Mental Health Parity Legislation
• Mental Health Parity Act (1996)
• Mental Health Parity and Addiction Equity Act (2008)
• MHPAEA Interim Final Rule (2010)
• Patient Protection and Affordable Care Act (ACA) (2010)
• MHPAEA Final Rule (2013)
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Mental Health Parity
Does not require that coverage be offered for any particular mental health condition or substance use disorder
Essential Health Benefits (10 categories)
Mental Health and Substance Use Disorders Service
Nicotine AddictionDSM V
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Mental Health Parity
Requires certain medical plans that cover mental health or substance use disorders to offer coverage for those services that is similar to coverage for medical / surgical benefits
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Mental Health Parity
“Comparable to” & “No more restrictive than”
1. Is the limitation applied to substantially all medical/surgical benefits
2. Is it the predominant treatment limitation
3. Is it more restrictive for MH/SUD benefits than for medical/surgical
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Mental Health Parity
“Comparable to” & “No more restrictive than”• Example:
– A plan has a “prior authorization” requirement for MH/SUD, but not for medical / surgical benefit
– The plan violates the MHPAEA because the offering of MH/SUD services cannot be more restrictive than those for medical / surgical
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Mental Health Parity
Six Classifications used to apply law
1. Inpatient, in-network
2. Inpatient, out-of-network
3. Outpatient, in-network
4. Outpatient, out-of-network
5. Emergency care
6. Prescription drugs
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Mental Health Parity
Parity within and across classifications
Inpatient, in-network
Medical/Surgical MH/SUD
Outpatient, out-of-network
MH/SUD
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MHPAEA Tobacco Cessation
Treatment for nicotine addiction does not have to be offered in a plan, but if offered:
• Should be offered across all plan classifications
• Limitations for nicotine addiction treatment should be comparable to those for medical / surgical conditions
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Mental Health Parity
Quantitative / Non-quantitative limitations
Quantitative • Frequency of treatment• Number of visits• Days of coverage
Non-quantitative• Medical management standards• Formulary design• Determination of usual/customary/reasonable
MH/SUD
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MHPAEA – Plans Covered
• Employer funded 50+ employees
• Non-grandfather employer funded plans with 50 or fewer employees
• Medicaid managed-care plans
• Children’s Health Insurance Plans
• Medicaid Alternative Benefits Plans
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MHPAEA – Plans NOT Covered
• Small employer plans created before 2010
• Church-sponsored plans
• Self-insured plans for stateand local government
• Retiree-only plans
• TriCare
• Medicare
• Traditional Medicaid
X
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MHPAEA Impact
• Between 2007 and 2011, mental health and substance use admissions increased
• Per capita spending on these admissions increased faster than spending on medical surgical
• Role of MHPAEA on this trend is not clear because of other possible contributing factors
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MHPAEA Implementation Dates
• New regulations effective Jan. 13, 2014
• Mental health parity provisions of final rule apply to plan years beginning on or after July 1, 2014.
• In interim, plans adhere to provisions of interim final rule.
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MHPAEA Enforcement
General Questions and Comments
• Department of Health and Human Services; Centers for Medicare and Medicaid ServicesHealth Insurance Helpline1-877-267-2323Email CMS Helpline: [email protected]
• Department of Labor1-866-444-3272
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MHPAEA / Cessation Resources
The Mental Health Parity and Addiction Equity Act and the Affordable Care Act: Implications for Coverage of Tobacco Cessation - http://www.publichealthlawcenter.org/sites/default/files/resources/tclc-fs-mhpaea-&-aca-2014_0.pdf
The Mental Health Parity and Addiction Equity Act: Key Elements and Implications for Smoking Cessation Therapies - http://www.ttac.org/tcn/peers/pdfs/10.26.10-B/SD_VCP01540_MHPAEA_White_Paper_Long.pdf
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ContactsTobacco Control Legal Consortium
www.tclconline.orgMaggie Mahoney(651) 290-7514
Public Health Law Centerwww.publichealthlawcenter.org
Warren Ortland(651) 290-7539