Health Plan Mandated Benefits

[Guidance Overview] Trial Court Rules for San Francisco in ERISA Preemption Challenge to'Fair Share'Law
Excerpt:"EBIA Comment: The enactment of federal health care reform may have impacted the final chapters of this nearly four-year litigation. According to an amicus brief filed by the Department of Justice (and reflecting the DOL's position) at the U.S. Supreme Court level, an appeal was not warranted because federal health care reform made it substantially unlikely that other state and local governments would enact laws like San Francisco's."(Employee Benefits Institute of America)

Mental Health Parity Act May Affect Your Medical Benefits
Excerpt:"The law takes effect at the beginning of a health plan's new year, so many people won't see any changes until January. At that point, people who will see the most benefit are those who previously had high copays and deductibles on mental health services."(Los Angeles Times)

[Guidance Overview] New Mental Health'Safe Harbor'Gives Health Plans Some Breathing Room
Excerpt:"Until final rules are issued, the enforcement safe harbor will allow health plans to split their outpatient classifications (in-network and out-of-network) into two subclassifications: office visits and all other outpatient items and services."(AIS Health.com)

[Guidance Overview] Mental Health Parity and Addiction Equity Act Compliance Alert (PDF)
Excerpt:"The Emergency Economic Stabilization Act of 2008 included provisions for permanent inclusion of the Mental Health Parity Act . . . as part of ERISA regulations."(William Gallagher Associates)

[Official Guidance] Text of Interim Final Regs for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services (PDF)
35 pages. The regulations are effective on September 17, 2010. (Internal Revenue Service, Department of the Treasury; Employee Benefits Security Administration, Department of Labor; Office of Consumer Information and Insurance Oversight, Department of Health and Human Services)

[Guidance Overview] DOL Clarification of Mental Health Parity Requirement
Excerpt:"The DOL's FAQ states that it will not take enforcement action against a plan or issuer that divides benefits furnished on an outpatient basis into two sub-classifications for purposes of applying the financial requirement and treatment limitation rules."(PricewaterhouseCoopers LLP)

[Guidance Overview] EBSA Allows New Sub-Classifications In Mental Health Parity Rules
Excerpt:"In a July 1 FAQ, EBSA noted, that until final rules are issued, an'enforcement safe harbor'will allow a plan or issuer to divide its benefits furnished on an outpatient basis into two sub-classifications for purposes of applying the financial requirement and treatment limitation rules under MHPAEA, as follows: (1) office visits, and (2) all other outpatient items and services."(Wolters Kluwer)

[Guidance Overview] DOL's FAQ on Mental Health Parity and Addiction Equity Act Regulations
Excerpt:"his FAQ will make it easier for plan sponsors to determine whether financial requirements (such as copayments) or treatment limits applicable to outpatient services for mental health or substance use disorders will be permissible under the MHPAEA regulations."(The Segal Group, Inc.)

How Do Employers React to a Pay-or-Play Mandate? Early Evidence from San Francisco
Excerpt:"There is substantial employer demand for the public option, with 21% of firms using Healthy San Francisco for at least some employees, yet there is little evidence of firms dropping existing insurance offerings in the first year after implementation."(National Bureau of Economic Research; paid subscription or individual purchase required to retrieve fulltext)

Researchers Report Average 21.7% Premium Growth for Employer-Sponsored Coverage for Private-Sector Employees in Massachusetts After State's Health Law Passage
Excerpt:"'Because the [Massachusetts] plan's main components are the same as those of the new health reform law, the effects of the plan provide a window into the country's future,'the authors wrote in a report published earlier this year by in the academic journal Forum for Health Economics&Policy."(Human Resource Executive Online)

[Guidance Overview] Employers Get More Time to Tweak Mental Health Coverage
Excerpt:"[F]ederal authorities will offer a temporary reprieve to employers that offer different levels of coverage for certain mental health outpatient services. Because many employers use copayments for medical office visits and coinsurance for all other outpatient medical services, neither one of those types of cost-sharing would not have met the'substantially all'test that had been set in the interim final rules that . . . took effect for plan years beginning on or after July 1, 2010. As a result, many employers would likely not have been permitted to require any cost-sharing of outpatient mental health services . . . ."(Business Insurance)

[Guidance Overview] DOL Releases Guidance on Mental Health Parity'Substantially All'Test
Excerpt:"Based on this new guidance, if all office visit services apply a copay, then copays would apply to substantially all outpatient office visit services. Therefore, a copay can apply to the outpatient MH/SUD benefit."(Hewitt)

[Guidance Overview] National Website on Health Insurance and Other Coverage Options Now Live
Excerpt:"Eventually, the site will provide resources on health plan eligibility, premiums, benefits and cost-sharing. Federal health reform announcements will also be posted on this site."(Mercer)

Health Insurers May Soon Offer Contraceptives at No Extra Cost
Excerpt:"Starting this fall, the health-care overhaul will require new health plans to begin providing a range of preventive health services at no cost to patients. Many people, including women's health advocates and some employer groups, think contraception should be one of the required free services."(Washington Post; free registration required)

'Healthy San Francisco'Law Clears Supreme Court Hurdle
Excerpt:"After four years, San Francisco on Monday won its legal battle to provide health care for all its residents when the U.S. Supreme Court refused to hear a business group's challenge to the Healthy San Francisco program."(San Francisco Chronicle)

Supreme Court Denies Request to Review Federal Appellate Court Ruling Backing San Francisco Health Care Spending Law
Excerpt:"The high court made the move without comment that effectively lets stand the decision by the 9th U.S. Circuit Court of Appeals in the matter of the San Francisco statute requiring companies with 100 workers or more to spend $1.96 per hour per covered employee on health coverage."(PLANSPONSOR.com)

Federal Judge Gives Agencies Go Ahead on Mental Health Rules
Excerpt:"Secretary of Labor Hilda L. Solis has announced a ruling by a federal judge in Washington that regulators have ???good cause??? to forego notice and comment on interim final rules regarding mental health services parity."(PLANSPONSOR.com)

Health Care Reform: Impact on Employer-Sponsored Plans Begins to Emerge
Excerpt:"This Perspective reviews some of the issues emerging as employers decide how to move forward with compliance."(Mercer LLC)

U.S. Defends Health Reform Against Lawsuits in Michigan, Virginia
Excerpt:"The administration said the mandate requiring most Americans to obtain health insurance coverage or face a tax penalty is not only an integral part of the reform law, but also falls well within Congress'powers to regulate areas impacting interstate commerce -- in this case, health care."(American Medical Association)

Administration Urges High Court to Leave SF Health Law Ruling Alone
Excerpt:"The Obama administration has reversed course in a long-running legal battle over a controversial San Francisco law requiring city employers to pay a minimum amount for worker health care plans."(PLANSPONSOR.com)

[Official Guidance] U.S. Solicitor General Amicus Brief in Golden Gate Restaurant Association v. City and County of San Francisco (PDF)
26 pages. Excerpt:"This brief is submitted in response to the order ofthis Court inviting the Solicitor General to express the views of the United States. In the view of the United States, the petition for a writ of certiorari should be denied."(American Benefits Council)

Supplemental Brief for Petitioner in Golden Gate Restaurant Association v. City and County of San Francisco (PDF)
15 pages. Excerpt:"QUESTION PRESENTED: Whether ERISA section 514(a), 29 U.S.C. ? 1144(a), preempts local laws mandating ongoing employer contributions for employee health benefits, or alter-native payments to a local government, and extensive recordkeeping and reporting and disclosure require-ments, a question on which the courts of appeals are in conflict."(American Benefits Council)

Obama Administration Sides with City in San Francisco Health Coverage Law Lawsuit
Excerpt:"San Francisco Chronicle:'The Obama administration took San Francisco's side Friday in a legal dispute over the city's groundbreaking health coverage law, urging the Supreme Court to reject an appeal by restaurant owners who objected to paying part of the cost. In a long-awaited filing, government lawyers said passage of national health insurance legislation'has dramatically changed the landscape'and reduced the likelihood that cities and states would adopt laws like San Francisco's."(Henry J. Kaiser Family Foundation)

Unwilling to Lose Grandfathered Status, Employers Fight Making Mental Health Parity Changes
Excerpt:"Between trying to comply with mental health parity regulations, due to take effect July 1, and implement provisions of health care reform, leaders from the American Benefits Council, National Retail Federation and U.S. Chamber of Commerce say benefits pros are at their limit. According to a recent report in Business Insurance, the groups are asking the Employee Benefits Security Administration to put off for a year the effective date for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act."(Employee Benefit News; free registration required)

Delay Sought for Mental Parity Rules
Excerpt:"Groups representing employers are asking the Employee Benefits Security Administration to delay the application of mental health parity regulations for at least a year, saying they were caught off guard by certain provisions and have been distracted by the passage of health care reform."(Business Insurance)

Requiring Individuals to Obtain Health Insurance: A Constitutional Analysis (PDF)
Excerpt:"This report first analyzes the authority of Congress to pass a law of this nature, as well as how a court could analyze this provision in light of a constitutional challenge based on various provisions of the Fifth and Tenth Amendments. Finally, this report discusses whether theexceptions to the individual responsibility requirement to purchase health insurance satisfy First Amendment freedom of religion protections."(Congressional Research Service via National Conference of State Legislatures)

Massachusetts Health Care Reform Fails Small Businesses
Excerpt:"The lack of focus on small businesses is evident. The [The Commonwealth Connector, an independent authority meant to act as an insurance plan clearinghouse,] took three years to make information about provider networks and participating primary care providers for small businesses available on its website. It took over two years to launch a small employer pilot program; in more than a year it attracted just 65 businesses and has now been replaced by a new program that offers only seven plans."(The Boston Globe)

Obama Administration Health Care Defense Offered
Excerpt:"The administration argues that consumer decisions to forgo health insurance do'substantially affect interstate commerce by shifting costs to health care providers and the public,'thus giving the government power to regulate via the Commerce Clause."(Capitol News Company LLC)

Insurer Seeks a Little Less Parity for Mental Health Coverage
Excerpt:"Specifically, [UnitedHealth Group] warned that if it cannot offer separate deductibles; for example, $250 each for mental health and other care, employers will combine them into a single, $500 deductible for everyone."(National Public Radio)

Fight Erupts Over Rules Issued for'Mental Health Parity'Insurance Law
Excerpt:"[I]nsurers say the Obama administration went overboard when it tried to regulate'nonquantitative treatment limits.'These include the techniques used by insurers to manage care, the criteria for selection of health care providers and the rates at which they are paid."(The New York Times; free registration required)

[Opinion] ERIC Comments on Interim Final Regulations Implementing Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (PDF)
16 pages. Excerpt:"The regulations should not require employers to aggregate separate plans."(The ERISA Industry Committee)

[Opinion] Text of Comments on Interim Final Regs. on Mental Health Parity, by Business Advocacy Groups (PDF)
8 pages. Excerpt:"We recommend that the Agencies delay the applicability date of the Regulation until the first plan year beginning on or after January 1, 2012. The current applicability date of the Regulation for most plan sponsors is the first plan year beginning on or after July 1, 2010."(American Benefits Council, National Retail Federation, U.S. Chamber of Commerce)

[Guidance Overview] Health Care Coverage for Adult Children: Steps to Take Now
Excerpt:"Employer Action Plan: [1] Employers who impute income for coverage provided to adult children should immediately cease imputing income for those who will not attain age 27 by the end of the year. [2] Group health plans providing coverage for dependents will have to be revised . . . [3] Employers should revise their cafeteria plans . . . [4] Employers who sponsor health FSAs and HRAs should decide whether to amend their plan so that expenses incurred for adult children will be reimbursable."(Seyfarth Shaw)

[Opinion] Constitution Puts Mandatory Health Insurance in Peril, Constitutional Law Prof Says
Excerpt:"It is true that the Supreme Court has interpreted the Commerce Clause broadly enough to reach wholly intrastate economic'activity'that substantially affects interstate commerce. But the Court has never upheld a requirement that individuals who are doing nothing must engage in economic activity by entering into a contractual relationship with a private company. Such a claim of power is literally unprecedented."(Wall Street Journal)

IRS Lacks Clout to Enforce Mandatory Health Insurance
Excerpt:"Starting in 2014, the agency will have [a massive] task: making sure all Americans have health insurance. Under the law, Americans who can afford health insurance but refuse to buy it will face a fine of up to $695 or 2.5% of their income, whichever is higher."(USA TODAY)

[Guidance Overview] Health Reform Act Requires Coverage of Adult Children But with Important'Grandfather Plan'Exception
Excerpt:"Grandfathered plans [(plans that were in existence on March 23, 2010)] must also provide adult children with coverage for plan years beginning on or after September 23, 2010, but only if the adult child is not eligible to enroll in another employer-sponsored plan. In 2014, grandfathered plans must offer coverage to otherwise eligible adult children even if they are eligible to participate in another employer-provided plan."(Thorp Reed&Armstrong)

[Opinion] Health Care Reform and Massachusetts
Excerpt:"Four years after Massachusetts enacted its ambitious health care reform, the state has achieved its goal: covering most of the uninsured without seriously straining its budget. Most citizens seem to like it. Massachusetts cannot stop there. It also needs to figure out how to rein in the escalating costs of medical care and health insurance. The new national reform law includes many provisions designed, over time, to reduce costs, but Massachusetts will have to move sooner."(The New York Times; free registration required)

San Francisco Increases Required Employer Health Spending
Excerpt:"San Francisco employers will have to dig a little deeper in their pockets next year to pay for the required health care spending under the city's controversial health coverage law. A posting on the city's Web site said employers with 100 or more employees in San Francisco will be required to spend $2.06 per hour per covered employee on health care beginning January 1, 2011, up from $1.96 in 2009. Employers with between 20 and 99 employees will have to spend at least $1.37 per hour, up from $1.31. Employers with fewer than 20 employees are exempt from the requirement."(PLANSPONSOR.com)

Lawsuit Challenges Validity of MHPAEA Regulations
Excerpt:"A coalition of managed behavioral healthcare organizations (MBHOs) has filed a lawsuit against the DOL, HHS, and Treasury to block implementation of regulations issued to enforce provisions of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). . . . The MHBOs, which contract with managed care organizations or with employers and states to manage behavioral healthcare on behalf of group health plans, challenged the regulations on various grounds. (Though not the focus of this preliminary decision, the coalition has alleged, among other things, that the regulations exceed the scope of what is permitted under the MHPAEA and that the federal agencies did not follow proper procedures in issuing the regulations.)"(Employee Benefits Institute of America)

Mental Health Care Benefits Organizations'Coalition Sues to Stop Implementation of Mental Health Parity Rule
Excerpt:"Business Insurance reports that the suit filed last week in U.S. District Court in Washington by the Coalition for Parity Inc. alleges that regulators failed to provide a'true and complete comment period,'which has resulted in'confusing, flawed and untested requirements.'In addition, while the interim final rule would ban the use of separate deductibles for mental health and medical treatment, the coalition says a single deductible for mental health and other medical services is a'requirement found nowhere'in the 2008 law."(PLANSPONSOR.com)

Filing Deadline Looms for San Francisco Health Mandate As Legal Challenge Continues
Excerpt:"By April 30, employers subject to San Francisco's health care spending mandate must file annual reports detailing expenditures made in 2009. City regulators have updated and clarified certain aspects of the program and released revised forms. As implementation of San Francisco's mandate continues, an ERISA challenge to the mandate awaits possible Supreme Court action. In the interim, federal regulators may further address the definition of health plans not governed by ERISA."(Mercer LLC)

[Guidance Overview] Fix COBRA, HIPAA and Other Group Health Plan Violations Quickly: Here's Why
Excerpt:"The Internal Revenue Code imposes an excise tax on employers who fail to comply with various federal mandates for group health plans like COBRA and HIPAA. . . . The IRS [has] issued final regulations for self-reporting (and paying) the excise tax for such violations and a new form (Form 8929) to use to self-report, starting this year."(Miller Johnson)

Most Large Employers Comply with Mental Health Parity Law, Hewitt Finds
Excerpt:"A recent survey of 70 Fortune 500 employers that offer mental health benefits found that none of the companies eliminated their mental health or substance abuse coverage because of the 2008 Mental Health Parity Act. According to the Hewitt Associates survey, all of the respondents eliminated their annual and lifetime maximums for mental health benefits as the law requires."(Employee Benefit Adviser; free registration required)

[Guidance Overview] Recent Developments in Employee Benefits and Executive Compensation, by Blank Rome, March 2010
Describes highlights of mental health parity regulation, revision of SEC executive compensation disclosure rules, issuance of model CHIP notice, and additional 403(b) DOL guidance. (Blank Rome)

[Guidance Overview] New Mental Health&Substance Abuse Parity Regulations May Require Health Plan Changes This Year
Excerpt:"The regulations are far more complex than anticipated and may require significant effort to ensure timely compliance. . . . Plan sponsors should consider all of their plan design options for complying with the 2008 Act, which may include more generous MH/SA benefits, less generous medical and surgical benefits, or some combination of the two."(Ivins, Phillips&Barker)

New Parity Rules Not Prompting Employers to Drop Mental Health Benefits
Excerpt:"Health care experts from Hewitt Associates, a global human resources consulting and outsourcing company, believe that despite the extra administrative and cost burden on U.S. employers, few companies will eliminate their existing mental health and substance abuse benefits as a result of new federal mental health parity regulations."(PLANSPONSOR)

[Guidance Overview] DOL Releases New Proposed Investment Advice Regulation
Target page contains link to 3-page overview. (Groom Law Group)

[Guidance Overview] New Interim Final Regulations on Mental Health Parity and Addiction Equity Act of 2008
Target page contains link to 8-page overview. (Groom Law Group)

[Guidance Overview] Mental Health Parity and Addiction Equity Act of 2008 Regulations Released
Excerpt:"The key issues addressed in the regulations are: Parity in medical management, a framework for parity comparison, and the prohibiting of specific plan designs. Plan sponsors that have already done an analysis and made changes to their design may have to revisit the analysis in light of the specific framework setout in the regulations. They will also have to take a closer look at medical management techniques to make sure they are compatible across all benefits."(Segal)

[Guidance Overview] New Interim Final Regulations on Mental Health Parity and Addiction Equity Act of 2008
Excerpt:"Overall, the Regulations were more expansive than many had anticipated and contained some surprises. Plan sponsors (many of whom adopted changes to their plan designs to comply with the Act without the benefit of interpretive guidance) will now need to review their plan designs to determine whether their plans are in parity under the rules as set forth in the Regulations -- particularly with regard to non-quantitative treatment limitations (such as medical management tools). Additionally, the parity tests for financial requirements and quantitative treatment limitations are complex and will require in-depth analysis. The Regulations provide a good faith compliance period until the applicability date, but there may be certain aggressive plan designs that plan sponsors may wish to change prior to the applicability date [of January 1, 2011 for most calendar year plans]."(Groom Law Group)

[Guidance Overview] Dependent Child Health Insurance Mandated in Wisconsin
Excerpt:"Employers who have fully-insured plans or governmental/school district self-insured plans are now required to cover adult children meeting the law's requirements on and after January 1, 2010. Employers affected by the new law are now required to offer coverage to adult children in two categories: . . . ."(Michael Best&Friedrich)

Chart of State Legislation Opposing Proposed Healthcare Legislation Mandating Coverage
Updated March 1, 2010. Excerpt:"As part of state-based responses to federal health reform legislation, individual members of at least 32 state legislatures are using the legislative process to seek to limit, alter or oppose selected state or federal actions, including single-payer provisions and mandates that would require purchase of insurance. In general the measures seek to make or keep health insurance optional, and allow people to purchase any type of coverage they may choose. The individual state language varies."(National Conference of State Legislatures)

[Guidance Overview] Overview of Interim Final Regulations on Mental Health Parity Law (PDF)
8 pages. Excerpt:"The Departments of Treasury, Labor, and Health and Human Services have released interim final regulations interpreting the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The regulations contain some complicated rules for determining parity and many employers will likely have to make significant changes in how they provide mental health and substance use disorder benefits to their employees."(Buck Consultants)

[Guidance Overview] Parity Law Expands Mental Health Access
Excerpt:"The law, which took effect for most plans Jan. 1, applies to groups of more than 50 employees . . . . Higher deductibles, steeper co-pays and other restrictions are no longer allowed for mental health and substance abuse treatment."(Kaiser Health News)

DOL Proposed Reg Defining'Welfare Plan'Would Create ERISA Preemption Carveout for Pay-or-Play Healthcare Laws
Excerpt:"With the U.S. Supreme Court yet to decide the fate of the San Francisco pay or play law, DOL is in the process of issuing a proposed regulation that would seek to exempt such laws from ERISA preemption."(HR Policy Association)

[Guidance Overview] Mental Health and Substance Abuse Benefits Must Meet New Parity Rules
Excerpt:"Sweeping regulations implementing the Mental Health Parity and Addiction Equity Act of 2008 give long-awaited guidance to ensure group health plans do not discriminate in benefits for mental health and substance abuse. While clarifying permitted and prohibited benefit features, the regulations set out data-intensive, numerical parity tests that may complicate evaluating certain plan designs. Other tests are more subjective, leaving uncertainty about some design elements. This Update answers basic questions about the new rules and offers practical dos and don'ts for employers to consider."(Mercer LLC)

[Guidance Overview] New Regulations for Mental Health and Substance Use Disorder Benefits (PDF)
6 pages. Excerpt:"Under the regulations, the parity requirements for financial requirements and treatment limitations apply separately tosix'classifications'of benefits. The six classifications are: Inpatient, In-Network; Inpatient, Out-of-Network; Outpatient, In-Network; Outpatient, Out-of-Network; Emergency Care; and Prescription Drugs."(Jones Day)

[Guidance Overview] Employers Offering Mental Health/Substance Use Benefits Should Evaluate Group Health Plan Design to Ensure Compliance with Requirements of Interim Final Regulations
Excerpt:"Specifically, group health plans must ensure that the financial requirements (such as copayments and deductibles) and treatment limitations (such as a limit on covered office visits) applicable to mental health and/or substance use disorder benefits are no more restrictive than the predominant requirements and limitations applied to substantially all medical and surgical benefits. The interim final regulations clarify that substantially all means at least two-thirds and predominant means more than one-half."(McDermott Will&Emery)

[Guidance Overview] Does Your Health Plan Violate the New Mental Health Parity Rules?
Excerpt:"Though these regulations withdraw prior rules that date to 1997, they do not answer all employer questions about the New Mental Health Parity Act ? such as questions concerning the exemption from the requirements for plans that experience certain cost increases from compliance. The regulators are seeking comments generally and on several specific questions through May 3, 2010."(Benefits eAuthority via Ogletree, Deakins, Nash, Smoak&Stewart, P.C.)

[Guidance Overview] New Interim Final Regulations on Mental Health Parity and Addiction Equity Act of 2008 (PDF)
8 pages. Excerpt:"The Regulations replace the prior mental health parity regulations effective April 5, 2010, and generally apply to group health plans and health insurance issuers for plan years beginning on or after July 1, 2010 (there is a special rule for collectively bargained plans ?see section G below). This means the provisions would be applicable on January 1, 2011 for most calendar year plans."(Groom Law Group)