The Wagner Law Group Description
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 23 attorneys engaged
exclusively in employee benefits, estate planning and
employment law. Seven 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
Francisco, CA 94104
November 14, 2013
State and Federal Law
DOL, HHS and
IRS Release Final Mental Health Parity Regulations
DOL, HHS and IRS
have issued final regulations implementing the Mental Health Parity
and Addiction Equity Act ("MHPAEA"), as amended by the
Patient Protection and Affordable Care Act ("PPACA").
Background. Adopted by
Congress in 2008, MHPAEA enhanced the mental health and substance
abuse parity protections for benefits provided by large group health
plans. MHPAEA's parity protections prohibit group health plans (both
self-funded and insured) that offer mental health and substance abuse
benefits from applying more restrictive financial or treatment limits
to these benefits than those restrictions applied to medical and
surgical benefits. The Agencies issued interim final regulations
implementing MHPAEA in February 2010.
MHPAEA's parity protections to the individual and small group
markets. PPACA also requires non-grandfathered health plans in the
individual and small group markets to cover mental health and
substance abuse benefits because they are "essential health
Under the final
- States may choose to mandate certain mental
health benefits for insured plans, and MHPAEA requires these
benefits to be in parity with the medical and surgical benefits
provided under the plan.
- The general parity requirements apply
separately to each type of financial requirement (e.g.,
deductibles, co-payments, co-insurance and out-of-pocket
deductibles) or treatment limit (e.g., annual visit
- The mental health parity provisions do not
apply to coverage provided under Medicaid or Medicare.
MHPAEA with PPACA.
regulations also address the interaction between MHPAEA and PPACA,
- No Lifetime or Annual Limits on EHBs. MHPAEA generally allows aggregate
lifetime and annual dollar limits on mental health or substance
abuse benefits if the limits are equal to those of medical and
surgical benefits provided under the plan. However, PPACA
prohibits annual and lifetime benefit limits on EHBs, which
include "mental health and substance use disorder services,
including behavioral health treatments." The final
regulations explain that MHPAEA's benefit limit requirements
only apply to non-EHBs.
- Coverage of Preventive Health Services. PPACA mandates that health plans must
cover certain preventive services without cost sharing, even
where the plan does not cover treatment for the underlying
condition that the preventive service is intended to diagnose.
The final regulations clarify that while PPACA requires plans to
cover certain preventive mental health or substance abuse benefits,
MHPAEA does not require coverage of additional mental health or
substance abuse benefits.
Effective Date of
Final Regulations. The final regulations apply to group health plans for
plan years beginning on or after July 1, 2014. Until the final
regulations become applicable, plans and issuers must continue to
satisfy the mental health parity provisions contained in the interim
regulations can be accessed at: http://www.dol.gov/ebsa/pdf/mhpaeafinalrule.pdf
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