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From the the first Annual National Conference on Tobacco and Behavioral Health, which occurred May 19-20, 2014 in Bethesda, MD and was hosted by the Central East Addiction Technology Transfer Center, a program of The Danya Institute. You can see videos from the conference on our website www.ceattc.org (go to “Tobacco and Behavioral Health Resources” under “Special Topics”). Warren Ortland, JD provides legal technical support to organizations working to increase the number of smoke-free multi-unit housing developments in the Twin Cities metro area, and technical assistance to Minnesota communities that are considering smoke-free ordinances. Prior to joining the Public Health Law Center, Warren was an Equal Justice Works Fellow, working for two years as the legislative research and policy coordinator at the Minnesota AIDS Project (MAP). At MAP, Mr. Ortland provided direct legal representation to HIV-positive clients in areas of employment, privacy and benefits. He also researched and drafted legislation on health care coverage for HIV-positive Minnesotans, prevention education funding for African-born immigrants, and HIV confidentiality protection. As a law student, Mr. Ortland was an editor on the William Mitchell Law Review. He is Secretary of the Board of Directors for the Minnesota State Bar Foundation, a board member of the Loan Repayment Assistance Program (LRAP) of Minnesota, and a member of the Legal Assistance to the Disadvantaged Committee. As a member of the Human Rights Committee of the Minnesota State Bar Association, He organized and moderated a CLE session on access to health care as a human rights issue.
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Mental Health Parity and Addiction Equity Act
(MHPAEA)
Access to Tobacco Cessation ServicesMay 19-20, 2014
Warren OrtlandStaff AttorneyTobacco Control Legal Consortium
The Tobacco Control Legal Consortium
A national legal network supporting tobacco control policy change.
Tobacco Law Centers
California
Minnesota
Michigan
Massachusetts
Maryland
New York
Who We Serve:
• Public health advocacy organizations and community coalitions
• Public health officials
• Elected officials
• City and county attorneys
• Private attorneys and individual citizens
What We Do:
• Policy development
• Litigation support
• Legal research, analysis, and interpretation
• Education and training
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 Addiction
DSM 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: [email protected]
• 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
Contacts
Tobacco Control Legal Consortiumwww.tclconline.org
Maggie Mahoney(651) 290-7514
Public Health Law Centerwww.publichealthlawcenter.org
Warren Ortland(651) 290-7539
