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The Wagner Law Group Description 

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 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.

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Massachusetts Office 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110


Florida Office 

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

   

San Francisco Office

Tel: (415) 625-0002

Fax: (415) 358-8300

315 Montgomery Street

Suite 904

San Francisco, CA 94104

 

www.wagnerlawgroup.com

 

 

November 14, 2013

 

 State and Federal Law Alert

 

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.

 

PPACA extends 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 benefits" ("EHBs").

 

Highlights of Final Regulations.
 

Under the final regulations:  

  • 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 limits).
  • The mental health parity provisions do not apply to coverage provided under Medicaid or Medicare. 

Interaction of MHPAEA with PPACA.

 

The final regulations also address the interaction between MHPAEA and PPACA, including: 

  • 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 final regulations.

 

The final regulations can be accessed at: http://www.dol.gov/ebsa/pdf/mhpaeafinalrule.pdf

 

This Newsletter is protected by copyright. Material appearing herein may be reproduced with appropriate credit.

  

Pursuant to Internal Revenue Service Circular 230, we hereby inform you that any advice set forth herein with respect to US federal tax issues is not intended or written by The Wagner Law Group to be used and cannot be used, by you or any taxpayer, for the purpose of avoiding penalties that may be imposed on you or any other person under the Internal Revenue Code.

 

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.