The Wagner Law Group
Wagner Law Group, A Professional Corporation, is a nationally
recognized ERISA & employee benefits, estate planning,
employment, labor & human resources practice.
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.
Wagner Law Group
Fax: (561) 293-3591
7108 Fairway Drive
Palm Beach Gardens, FL 33418
East Kennedy Boulevard
Tampa, FL 33602
Francisco, CA 94104
100 South 4th Street, Suite 550
St. Louis, MO 63102
November 10, 2016
Health and Welfare Law
Agencies Release ACA
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
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.
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.
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
comments on the application of medical management limits to
tobacco cessation services and products.
Regarding compliance with MHPAEA, FAQs XXXIV:
group health plan sponsors' disclosure obligations to current or
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.
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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