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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 six 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 27 attorneys, senior benefits consultant and three 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 2016, 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 Ave., N.W.

Suite 810

Washington, D.C. 20006

 


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

 

 

www.wagnerlawgroup.com

 

 

 

June 29, 2017

 

 Health and Welfare Law Alert

 

 

 

Agencies Release FAQs on Mental Health Parity 

 

 

 

DOL, HHS and IRS have released FAQs About Affordable Care Act Implementation Part XXXVIII. Specifically, FAQs XXXVIII address whether certain requirements under the Mental Health Parity and Addiction Equity Act ("MHPAEA") apply to benefits that a group health plan or health insurance issuer may offer for treatment of an eating disorder.

 

In addition, FAQs XXXVIII also provide access to a draft model disclosure form to be used by participants to request certain disclosures related to non-quantitative treatment limitations ("NQTLs") under a group health plan or insurance policy.

 

Background. The MHPAEA, which was amended by the Affordable Care Act and 21st Century Cures Act, says that the financial requirements and treatment limitations applicable to a group health plan's mental health and substance use benefits ("MH/SUD benefits") cannot be more restrictive than the financial requirements and treatment limitations for other medical and surgical benefits.

 

The MHPAEA also requires a group health plan or issuer to disclose, upon request of a participant or beneficiary, the criteria for medical necessity determinations that apply to MH/SUD benefits.

 

FAQs XXXVIII. FAQs XXXVIII confirm that eating disorders are mental health conditions. Accordingly, treatment of an eating disorder is a mental health benefit within the meaning of that term under the MHPAEA. Therefore, a group health plan that imposes more restrictive financial requirements and treatment limitations on eating disorder treatments will violate the MHPAEA, which can result in significant liability for plan sponsors.

 

FAQs XXXVIII also include a link to a draft model form that participants, enrollees or their authorized representatives may use to request information from their health plan or issuer regarding NQTLs that may affect their MH/SUD benefits, or obtain information after an adverse benefit determination involving MH/SUD benefits to support an appeal.

 

  

 

 

 

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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.