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The Wagner Law Group

The Wagner Law Group is a nationally recognized practice in the areas of ERISA and employee benefits, estate planning, employment, labor and human resources and investment management.

 

Established in 1996, The Wagner Law Group is dedicated to the highest standards of integrity, excellence and thought leadership and is considered to be amongst the nation's premier ERISA and employee benefits law firms. The firm has seven offices across the country, providing unparalleled legal advice to its clients, including large, small and nonprofit corporations as well as individuals and government entities worldwide. The Wagner Law Group's 34 attorneys, senior benefits consultant and five paralegals combine many years of experience in their fields of practice with a variety of backgrounds. Seven of the attorneys are AV-rated by Martindale-Hubbell and six are Fellows of the American College of Employee Benefits Counsel, an invitation-only organization of nationally recognized employee benefits lawyers.  Seven of the firm's attorneys have been named to the prestigious Super Lawyers list for 2017, which highlights outstanding lawyers based on a rigorous selection process.

 

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Boston 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110

 

Washington, D.C.

Tel: (202) 969-2800

 

Fax: (202) 969-2568

 800 Connecticut Avenue, N.W.

Suite 810

Washington, D.C. 20006

 

Chicago

Tel: (847) 990-9034

Fax: (847) 557-1312

190 South LaSalle Street

Suite 2100

Chicago, IL 60603

 

  

Palm Beach Gardens 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

Tampa

Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 

  

San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

300 Montgomery Street

Suite 600

San Francisco, CA 94104

  

St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
25 W. Moody Avenue
St. Louis, MO  63119 

 

Lincoln

Tel: (617) 532-8080

Fax: (617) 532-9090

55 Old Bedford Road

Lincoln, MA 01773

 

 

www.wagnerlawgroup.com

 

 

 

   Agencies Issue Proposed FAQs on Mental Health Parity Implementation

 

April 26, 2018

 

 

 

HHS, DOL and IRS (the "Agencies") have jointly issued proposed FAQs to provide guidance on the implementation of the requirements of the Mental Health Parity and Addiction Equity Act of 2008 (the "MHPAEA"). 


Background.  In general, MHPAEA requires that the financial requirements (e.g., coinsurance and copays) and treatment limitations (e.g., visit limits) imposed on mental health or substance use disorder ("MH/SUD") benefits cannot be more restrictive than the predominant financial requirements and treatment limitations that apply to substantially all medical/surgical benefits in a classification.


With regard to any non-quantitative treatment limitation ("NQTL"), the MHPAEA final regulations provide that a group health plan or health insurance issuer may not impose a NQTL with respect to MH/SUD benefits in any classification unless, under the terms of the plan (or health insurance coverage) as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the NQTL to MH/SUD benefits in the classification are comparable to, and are applied no more stringently than,  the processes, strategies, evidentiary standards, or other factors used in applying the limitation to medical/surgical benefits in the same classification.


MHPAEA also imposes certain disclosure requirements on group health plans and health insurance issuers.


Proposed FAQs.  Among other things the proposed FAQs clarify that under MHPAEA:

 

  • A health plan cannot:

 

  • Deny (as experimental or investigative) claims for Applied Behavioral Analysis therapy to treat children with Autism Spectral Disorder that is supported by professionally-recognized treatment guidelines when the plan approves treatment for medical/surgical conditions that are supported by similar guidelines.
  • Set dosage limits for prescription drugs used to treat MH/SUD disorders that are less than the professionally-recognized treatment guidelines, when the dosage limits set by the plan for medical/surgical benefits equal or exceed the treatment guideline limits.
  • Pay reduced reimbursement rates to non-physician practitioners providing MH/SUD services where the plan does not pay reduced reimbursement rates to non-physician practitioners who provide medical/surgical services.
  • Exclude coverage for inpatient, out-of-network treatment outside of a hospital for eating disorders (e.g., a residential treatment center) when the plan covers such treatments for medical/surgical conditions when there is physician authorization and determination that the treatment is medically appropriate based on clinical standards of care.

 

  • An exclusion of all benefits for a particular condition or disorder is not a treatment limitation for purposes of the definition of "treatment limitations" in the MHPAEA regulations.  For example, under MHPAEA a group health plan may contain a general exclusion for items and services to treat bipolar disorder, including prescription drugs. 

 

NOTE:  Small employer group health insurance coverage and individual health insurance coverage are subject to the ACA requirement to provide essential health benefits ("EHB"s), and the determination of whether certain benefits must be covered depends on the applicable state's EHB benchmark plan.

 

  • If a health plan uses a provider network, its SPD must provide a general description of the network along with a listing of providers that is up-to-date, accurate and complete. 

 

NOTE: The provider list may be furnished in a separate document that is accompanied by the plan's SPD if it is furnished automatically and without charge and the SPD contains a statement to that effect.

 

  • Health plans that utilize provider networks can satisfy applicable disclosure requirements by providing a hyperlink or URL address in enrollment and plan summary materials for a provider directory where information related to MH/SUD providers can be found.

The proposed FAQs are available at: https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-39-proposed.pdf

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.