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Employers updated on latest health care reform news and educated on new mental health parity rules

On December 3, BHCG sponsored a presentation by attorney John Barlament, a partner with Quarles & Brady, LLP, to the Benefits Subcommittee. John provided a benefit plan legal update and guidance about new rules related to the Mental Health Parity and Addiction Equity Act (MHPAEA).

Health Care Reform Update

  • Like many observers, John was somewhat surprised the U.S. Supreme Court agreed to hear the appeal of a July 22 U.S. District Court ruling concerning the validity of a key Affordable Care Act (ACA) component – specifically the provision of the law that allows the federal government to distribute tax credits (subsidies) to people buying coverage through the ACA’s health insurance marketplace. The challengers in the case, King v. Burwell, maintain the provision in the law limits subsidies to “an exchange established by the state” and only people in states with their own exchanges can get subsidies. John predicts the Supreme Court will ultimately uphold use of subsidies in states with federal exchanges.
  • Once the Republicans take control of the Senate in January, it is likely a bill repealing the ACA will be sent to President Obama. He will veto it, but it may open the door to discussions about some modifications to the ACA, including changing the definition of a full-time employee and a possible repeal of the medical device tax.
  • The Chicago office of the Equal Employment Opportunity Commission (EEOC) has recently sued three employers (Honeywell, Orion Energy Systems and Flambeau, Inc.) over their wellness plans, asserting they violate the Americans with Disabilities Act (ADA). The EEOC is alleging that the employers’ wellness programs are not “voluntary” due to the “large” and “substantial” penalties to those who chose not to participate. Because the program was involuntary, the disability related inquiries and medical examinations within the program violate the ADA, according to the EEOC. These cases are pending and it remains to be seen how they will be resolved.

Mental Health Parity

John’s presentation, entitled, The New Mental Health Parity Rules: Action Items for TPAs and Employers, provided employers a step-by-step analysis of the new rules associated with MHPAEA. Employers were also provided a 50-page toolkit to assist them in complying with the new rules.

The MHPAEA established three main requirements with the goal of ensuring mental health (MH) and substance use disorder (SUD) benefits were not unfairly subjected to limits not applicable to medical /surgical benefits. Parity must exist between medical/surgical and MH/SUD benefits in the following areas:

  • Annual and/or lifetime dollar limits
  • Financial requirements (e.g., deductibles, co-payments) and quantitative treatment limitations (e.g., number of treatments, visit limits, days of coverage)
  • Non-quantitative treatment limitations (e.g., medical management standards)
Employers interested in learning more about the mental health parity toolkit, should contact Jennifer LaMere at 414-433-4984 x3 or at jlamere@businesshealthcaregroup.org.

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