The federal Departments of Health and Human Services, Labor, and the Treasury (the “Agencies“) recently issued a set of Frequently Asked Questions, Part 34 (the “FAQs“), regarding the coverage of certain preventive services under the ACA and the implementation of requirements under the Mental Health Parity and Addiction Equity Act, as amended by the ACA (the “MHPAEA“). With respect to preventive services, the FAQs (i) highlight updated recommendations issued in 2015 by the U.S. Preventive Services Task Force (which form the basis, in part, of the ACA preventive services requirements) regarding tobacco cessation and (ii) request comments on several questions about items and services that must be provided without cost-sharing by health plans and health insurance issuers for compliance with the updated recommendations. The updated recommendations become effective the first day of the plan/policy year beginning on or after September 22, 2016 (i.e., January 1, 2017 for calendar year plans/policies). The FAQs also include a request for comments on several questions regarding participant disclosures under the MHPAEA, including whether the Agencies’ issuance of model forms for use by participants to request information from a plan or issuer related to “nonquantitative treatment limitations” (“NQTLs“) would be helpful. Finally, the FAQs provide a number of fact patterns, in a Q&A format, which are related to whether a plan/issuer’s NQTLs would be permissible under the MHPAEA. NQTLs addressed in these Q&As include (x) a plan requirement for “in-person” examination of a participant seeking inpatient, in-network mental health treatment to determine medical necessity of the treatment, and (y) a plan requirement for preauthorization of a prescription drug for the treatment of an opioid use disorder based on the safety risks associated with the drug.
The FAQs are available here.