FAQs Discuss Mental Health Parity, Summary of Benefits and Coverage
Health Care Reform
Final regulations regarding the Summary of Benefits and Coverage (SBC), required to be implemented next year under the Patient Protection and Affordable Care Act (ACA) likely will “include an applicability date that gives group health plans and health insurance issuers sufficient time to comply.” This means that the statutory effective date of March 23, 2012, could be delayed.
This information is included in ACA frequently-asked-question released on November 17 by the Employee Benefits Security Administration.
Also included in the November 17 FAQs are a number of questions regarding implementation of the interim final rules for the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
Among the answers regarding the MHPAEA, EBSA makes it clear that a group health plan may not require prior authorization from the mental health plan’s utilization reviewer that a treatment is medically necessary when the plan does not require such prior authorization for any medical/surgical benefits.
The FAQs also clarify that the standard for determining the maximum copayment that can be applied to mental health/substance abuse disorder benefits is determined by the predominant copayment that applies to substantially all medical/surgical benefits within a classification.
If the copayment that meets this standard is the one charged for a medical/surgical specialist, that copayment can be charged for all mental health/substance use disorder benefits within that classification. On the other hand, if the copayment that meets this standard is the one charged for a medical/surgical generalist, then that is the copayment that can be charged to all mental health/substance use disorder benefits within that classification.
Source: FAQs About Affordable Care Act Implementation Part VII and Mental Health Parity Implementation, November 17, 2011, http://www.dol.gov/ebsa.