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The Wagner Law Group

The Wagner Law Group, A Professional Corporation, is a nationally recognized ERISA & employee benefits, estate planning, employment, labor & human resources practice. 

 

Established in 1996, The Wagner Law Group has 26 attorneys engaged exclusively in employee benefits, estate planning and employment law. Six of our attorneys are AV rated by Martindale-Hubbell as having very high to preeminent legal abilities and ethical standards. The firm is among the largest ERISA boutiques in the country. Our practice is national in scope, with clients in more than 40 states and several foreign countries.

 

 

 

 

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


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
100 South 4th Street, Suite 550
St. Louis, MO  63102 

 

www.wagnerlawgroup.com

 

 

 

 

November 10, 2016

 

 Health and Welfare Law Alert

 

 

 

 Agencies Release ACA FAQs XXXIV

 

 

 

 

 

DOL, HHS and IRS have released FAQs About Affordable Care Act Implementation Part XXXIV ("FAQs XXXIV").  Specifically, FAQs XXXI addresses compliance with the Affordable Care Act's ("ACA's") preventive services requirements and the Mental Health Parity and Addiction Equity Act of 2008 ("MHPAEA"). 

 

 

Background.  The ACA requires non-grandfathered group health plans to cover certain preventive services, including tobacco cessation interventions, without imposing any cost-sharing requirements on participants.

 

 

The MHPAEA says that the financial requirements and treatment limitations applicable to a group health plan's mental health and substance abuse benefits ("MH/SUD benefits") cannot be more restrictive than the financial requirements and treatment limitations for other medical and surgical benefits.

 

 

Preventive Services.  FAQs XXXIV provide updated recommendations on the coverage of tobacco cessation interventions.  Specifically, FAQs XXXIV:

 

  • confirm that a combination of behavioral and drug interventions for tobacco use are most effective and should be offered; and
  • seek comments on the application of medical management limits to tobacco cessation services and products.

 

MHPAEA.  Regarding compliance with MHPAEA, FAQs XXXIV:

 

  • Address group health plan sponsors' disclosure obligations to current or potential participants.
  • Provide information on how a participant can contact certain federal and state agencies for help in obtaining and interpreting documents related to MH/SUD benefit denials.
  • Explain that group health plans generally must use their own claims data in performing the quantitative and financial tests required by MHPAEA.  However, FAQs XXXIV confirm that a plan may use claims data collected from similar group health plans if a qualified actuary determines that the plan's claims data does not provide a reasonable basis for projecting costs.
  • Discuss certain questions about non-quantitative treatment limitations that present parity issues.
  • Cover the application of MHPAEA's parity rules to medication for the treatment of opioid use disorders.

 

 

 

 

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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.