Mental Health Parity and Addiction Equity Act

(MHPAEA)Access to Tobacco Cessation Services

May 19-20, 2014

Warren OrtlandStaff AttorneyTobacco Control Legal Consortium

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Paul Wellstone & Pete Domenici Mental Health Parity and Addiction Equity Act

of 2008 (MHPAEA)

Mental Health Parity Legislation

• Mental Health Parity Act (1996)

• Mental Health Parity and Addiction Equity Act (2008)

• MHPAEA Interim Final Rule (2010)

• Patient Protection and Affordable Care Act (ACA) (2010)

• MHPAEA Final Rule (2013)

Mental Health Parity

Does not require that coverage be offered for any particular mental health condition or substance use disorder

Essential Health Benefits (10 categories)

Mental Health and Substance Use Disorders Service

Nicotine AddictionDSM V

Mental Health Parity

Requires certain medical plans that cover mental health or substance use disorders to offer coverage for those services that is similar to coverage for medical / surgical benefits

Mental Health Parity

“Comparable to” & “No more restrictive than”

1. Is the limitation applied to substantially all medical/surgical benefits

2. Is it the predominant treatment limitation

3. Is it more restrictive for MH/SUD benefits than for medical/surgical

Mental Health Parity

“Comparable to” & “No more restrictive than”• Example:

– A plan has a “prior authorization” requirement for MH/SUD, but not for medical / surgical benefit

– The plan violates the MHPAEA because the offering of MH/SUD services cannot be more restrictive than those for medical / surgical

Mental Health Parity

Six Classifications used to apply law

1. Inpatient, in-network

2. Inpatient, out-of-network

3. Outpatient, in-network

4. Outpatient, out-of-network

5. Emergency care

6. Prescription drugs

Mental Health Parity

Parity within and across classifications

Inpatient, in-network

Medical/Surgical MH/SUD

Outpatient, out-of-network

MH/SUD

MHPAEA Tobacco Cessation

Treatment for nicotine addiction does not have to be offered in a plan, but if offered:

• Should be offered across all plan classifications

• Limitations for nicotine addiction treatment should be comparable to those for medical / surgical conditions

Mental Health Parity

Quantitative / Non-quantitative limitations

Quantitative • Frequency of treatment• Number of visits• Days of coverage

Non-quantitative• Medical management standards• Formulary design• Determination of usual/customary/reasonable

MH/SUD

MHPAEA – Plans Covered

• Employer funded 50+ employees

• Non-grandfather employer funded plans with 50 or fewer employees

• Medicaid managed-care plans

• Children’s Health Insurance Plans

• Medicaid Alternative Benefits Plans

MHPAEA – Plans NOT Covered

• Small employer plans created before 2010

• Church-sponsored plans

• Self-insured plans for stateand local government

• Retiree-only plans

• TriCare

• Medicare

• Traditional Medicaid

X

MHPAEA Impact

• Between 2007 and 2011, mental health and substance use admissions increased

• Per capita spending on these admissions increased faster than spending on medical surgical

• Role of MHPAEA on this trend is not clear because of other possible contributing factors

MHPAEA Implementation Dates

• New regulations effective Jan. 13, 2014

• Mental health parity provisions of final rule apply to plan years beginning on or after July 1, 2014.

• In interim, plans adhere to provisions of interim final rule.

MHPAEA Enforcement

General Questions and Comments

• Department of Health and Human Services; Centers for Medicare and Medicaid ServicesHealth Insurance Helpline1-877-267-2323Email CMS Helpline: phig@cms.hhs.gov

• Department of Labor1-866-444-3272

MHPAEA / Cessation Resources

The Mental Health Parity and Addiction Equity Act and the Affordable Care Act: Implications for Coverage of Tobacco Cessation - http://www.publichealthlawcenter.org/sites/default/files/resources/tclc-fs-mhpaea-&-aca-2014_0.pdf

The Mental Health Parity and Addiction Equity Act: Key Elements and Implications for Smoking Cessation Therapies - http://www.ttac.org/tcn/peers/pdfs/10.26.10-B/SD_VCP01540_MHPAEA_White_Paper_Long.pdf

ContactsTobacco Control Legal Consortium

www.tclconline.orgMaggie Mahoney(651) 290-7514

maggie.mahoney@wmitchell.edu

Public Health Law Centerwww.publichealthlawcenter.org

Warren Ortland(651) 290-7539

warren.ortland@wmitchell.edu