ACA Round-Up: Mental Health And Substance Use Parity, Premium Tax Credits, And A New Marketplace Reinsurance Proposal

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that the financial requirements and treatment limitations imposed on mental health and substance use disorder (MH/SUD) benefits must not be more restrictive than the predominant financial requirements and treatment limitations imposed on substantially all medical and surgical benefits. The MHPAEA requires plans and insurers to disclose their criteria for making medical necessity determinations with respect to MH/SUD to any current or potential participant, beneficiary, or contracting provider, and to make available the reasons for denial of payment with respect to MH/SUD benefits to any participant or beneficiary.
To evaluate MH/SUD parity, disclosures are also needed respecting medical/surgical services, particularly with respect to non-quantitative treatment limitations (NQTLs) such as medical necessity determinations or step therapy requirements. Thus, previous regulations and guidances have recognized broad NQTL disclosure requirements under the MHPAEA, the Employee Retirement Income Security Act, and the Affordable Care Act. In October of 2016, the Departments that administer these acts (Labor, Treasury, and Health and Human Services) requested comments on model forms that could be used by participants and beneficiaries to seek information respecting NQTLs, and by state regulators overseeing compliance with MHPAEA requirements. The Twentieth Century Cures Act further required the Departments to s...

Source: Health Affairs Blog - June 16, 2017 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Mental Health Parity and Addiction Equity Act reinsurance Source Type: blogs