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Compliance Update
Q3 2021

MHPAEA Requirements, FAQs about the Affordable Care Act, and the Kelley v. Azar II (previously Kelley v. Becerra) case on the Affordable Care Act’s preventive care provisions

Mental Health Parity and Addiction Equity Act (MHPAEA)

 

What it is:

The Consolidated Appropriations Act of 2021 (the “CAA”), signed into law on December 27, 2020, contains requirements for certain employer-sponsored health plans to further comply with the federal Mental Health Parity and Addiction Equity Act (“MHPAEA”). MHPAEA deals with the equal coverage of mental health/substance abuse care and medical/surgical benefits.

Status:

With the passage of the CAA, employers must now provide evidence of compliance upon request from regulators. MHPAEA requires plans be reviewed for compliance with quantitative and non-quantitative treatment limitations.

What you need to know:

Included among the CAA’s changes are new MHPAEA requirements, beginning forty-five (45) days after the CAA’s enactment, to make available to the Secretary, upon request, the comparative analyses and the following information:

i. The specific plan terms or other relevant terms regarding the NQTLs and a description of all mental health or substance use disorder and medical or surgical benefits to which each such term applies in each respective benefits classification.

ii. The factors used to determine that the NQTLs will apply to mental health or substance use disorder benefits and medical or surgical benefits.

iii. The evidentiary standards used for the factors identified in clause (ii), when applicable, provided that every factor shall be defined, and any other source or evidence relied upon to design and apply the NQTLs to mental health or substance use disorder benefits and medical or surgical benefits.

iv. The comparative analyses demonstrating that the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to mental health or substance use disorder benefits, as written and in operation, are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to medical or surgical benefits in the benefits classification.

v. A disclosure of the specific findings and conclusions reached by the group health plan, including any results of the analyses described in this subparagraph that indicate that the plan is or is not in compliance with this section.

MHPAEA is a complex requirement that requires an in-depth analysis of claims and plan design elements. Linked below are additional resources and relevant information on the MHPAEA and the Appropriations Act:

Department of Labor Self-Compliance Tool for the MHPAEA

General Information

If you are a Healthgram client, contact your Account Manager to learn how we can support you with the MHPAEA mandate.

 

Affordable Care Act Frequently Asked Questions

 

What it is:

The Centers for Medicare & Medicaid Services (“CMS”) outlined frequently asked questions (the “FAQs”) in regards to the implementation of the Affordable Care Act (the “ACA”).

Status:

The Departments of Labor, Health and Human Services (“HHS”), and the Treasury collectively prepared the FAQs to help foster a better understanding of the law and promote compliance with its terms.

What you need to know:

The proposed 2022 Notice of Benefit and Payment Parameters (“NBPP”) would have been $9,100 for self-only coverage and $18,200 for other than self-only . However, the HHS finalized a change in the calculation of the premium adjustment percentage and cost-sharing parameters that lowered the values for the maximum annual limitation on cost-sharing for self-only and other than self-only coverage for the 2022 plan year.

The maximum out-of-pocket limit for plan years beginning on or after January 1, 2022 is as follows:

 

Self-Only Coverage Other Than Self-Only Coverage
$8,700 $17,400

 

The FAQs provides additional details on why the HHS finalized different maximum out-of-pocket limits for the 2022 plan year than the ones that were initially proposed.

 

The Kelley v. Azar II case on the Affordable Care Act’s Preventive Care Provisions

 

What it is:

Kelley v. Azar II is the next round of litigation challenging major provisions of the ACA. The case aims to remove many provisions of Obamacare that require certain preventive care services be covered by health insurers.

There are several provisions in the ACA that require group and individual health plans to cover various preventive treatments without imposing any cost-sharing requirements. When Congress wrote the ACA, it did not itemize which treatments must be covered – instead, it delegated that authority to three different governmental bodies.

– The United States Preventive Services Task Force (“USPSTF”);

– The Advisory Committee on Immunization Practices (“ACIP”) of the Centers for Disease Control and Prevention; and,

– The Health Resources and Services Administration, a federal agency within the Department of Health and Human Services.

Status:

Kelley v. Azar II is a pending court proceeding before United States District Court Judge Reed O’Connor (the same judge who invalidated the entirety of the ACA in 2018) which could potentially endanger patients’ access to preventive services that are currently covered under the ACA.

What you need to know:

– The Kelley plaintiffs are raising several legal claims against the ACA’s preventive care provisions including the claim that the USPSTF and the ACIP are not technically composed of “Officers of the United States” and therefore cannot impose regulatory decisions in regard to the items that are added to the preventive services list.

– Preventive services often cover the cost of vaccines, bloodwork, contraceptive care, screenings for diseases and some forms of cancer, and more.

– If the Kelley plaintiffs’ succeed, insurers could have the ability to choose not to cover preventive care services and/or impose new costs on patients who seek those services.

– The current Scheduling Order details the next steps in the case, which include the following important dates

 – 1 October 2021: conclusion of discovery

 – 1 November 2021: Plaintiffs’ Motion for Summary Judgment

For more information on Kelley v. Azar II, visit this source

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