Complying With the Mental Health Parity and Addiction Equity Act

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Place an order or get more information at 800-521-4323 Price: $179 Pages: 52 ISBN:1-933801-66-2 © 2009 Pub Code: BMHP

Complying With the Mental Health Parity and Addiction Equity Act is a practical new softbound book that provides insight into the recently enacted Mental Health Parity and Addiction Equity Act’s legal requirements and hands-on guidance for making the complicated benefit design decisions that need to be made very soon.

Final regulations will be issued soon under the groundbreaking new mental health parity law, which requires significant changes to health plan benefit designs.

Any insurer or employer that offers mental health benefits must now cover mental illnesses and substance-abuse disorders on the same terms and conditions as other illnesses. While this general requirement sounds quite simple, the details demand that a number of complex compliance decisions be made, with a January 1, 2010, effective date rapidly approaching.

In addition to having a dramatic impact on health plan benefit designs, this new law will affect virtually every employer with 50 or more employees.

Two Editions for the Price of One

The First Edition of Complying With the Mental Health Parity and Addiction Equity Act was written based on proposed rules issued on April 28, 2009, by the IRS, CMS and Labor Department.

When you purchase the First Edition of this highly practical new book, which is now available, you will also receive a complimentary copy of the Second Edition, to be issued shortly after final regulations are out.

Order your copy today!

 

Table of Contents

Chapter 1: Introduction

• Background
• Overview of the Wellstone Act
• What Plans Are Subject to the Act?
• Exemptions
• Defining ‘Mental Health and Substance Abuse’
• State Law Issues
• Effective Date

Chapter 2: Defining ‘Mental Health Benefits’ and ‘Substance Abuse Benefits’

• The DSM-IV
• Possible Limitations on Plan Sponsor Definitions
• Using Definitions to Control Cost
• Preemption of State Law Definitions for Self-Insured Plans

Chapter 3: Financial Requirements

• Clarification of “Predominant” and “Substantially All”
• ’Separate but Equal’ Financial Requirements
• Deductibles
• Out-of-Pocket Maximums

Chapter 4: Treatment Limitations

• Medical Management Tools
• Out-of-Network Providers
• Are EAPs a Special Case?  

Chapter 5: Exemptions

• The Small Employer Exception
• Exceptions for Certain Benefits
• Cost Exemption
• Opt-Out for Non-Federal Governmental Self-Funded Plans

Chapter 6: Other Wellstone Act Provisions

• Availability of Plan Information
• Union Plans
• Enforcement
• GAO Study

Chapter 7: Compliance Roadmap

• Standards mandated by the 1996 MHPA
• Financial requirements of mental health and substance abuse benefits
• Treatment limitations
• “Hidden” treatment limitations and financial requirements
• Defining “mental health or substance abuse benefits”
• Out-of-network versus in-network benefits
• Criteria for medical necessity determinations
• Policy and procedure for notifying participants of denials of benefits
• Reviewing and understanding the cost exemption
• Providing the proper notices to employees and CMS

Appendices

• Statutory Language
• Regulations
• Model Notices

Written By

John R. Hickman, Esq. is head of the Health Benefits Practice at Alston & Bird, LLP, where he leads several attorneys devoted exclusively to HIPAA privacy, flexible benefits and other health and welfare benefit issues. He has been a pioneer in the consumer directed health care arena and has worked closely with health plans, financial institutions, and employers with regard to such arrangements. Mr. Hickman has been listed in The Best Lawyers in America (Woodward/White) and Who’s Who Legal in the employee benefits area. He has lectured widely and published articles on HIPAA, ERISA litigation, cafeteria and health plan issues. Mr. Hickman is head of the Technical Advisory Committee and is on the board of the Employers Council on Flexible Compensation. He is an adjunct professor of law at Emory University School of Law.

Laurie Kirkwood, Esq. is an associate in the Atlanta office of Alston & Bird, LLP, where her practice focuses exclusively on health benefit issues affecting health plans and employer plan sponsors. She is a frequent author and speaker on health benefit issues.

 

Written For

Financial managers, medical officers, clinical services directors, compliance officers, product developers, and marketing directors at health plans and large employer purchasers.

 

Shipping Information

This item is shipped via UPS. Please give us your street address when you order (UPS does not deliver to PO boxes.) You should receive your order within 5-7 business days. Shipping cost is $5 per item.

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