Text of Agency FAQs on ACA Implementation: (Part XXIX) and Mental Health Parity Implementation

BenefitsLink.com

October 23, 2015

13 Q&As. “Coverage of Preventive Services … Are plans and issuers required to provide a list of the lactation counseling providers within the network?…. My non-grandfathered group health plan or coverage contains a general exclusion for weight management services for adult obesity. Is this permissible?… If a colonoscopy is scheduled and performed as a screening procedure pursuant to the USPSTF recommendation, is it permissible for a plan or issuer to impose cost sharing for the required specialist consultation prior to the screening procedure?… I am a qualifying non-profit or closely held for-profit employer who sponsors an ERISA-covered self-insured plan, and I have a sincerely held religious objection to providing coverage of contraceptive services. How do I effectuate the religious accommodation, relieving myself of any obligation to contract, arrange, pay, or refer for that coverage?…

Coverage of BRCA Testing … Which women must receive coverage without cost sharing for genetic counseling, and if indicated, testing for harmful BRCA mutations?…

Wellness Programs … My group health plan gives rewards in the form of non-financial (or in-kind) incentives (for example, gift cards, thermoses, and sports gear) to participants who adhere to a wellness program. Are these non-financial incentives subject to the wellness program regulations issued by the Departments? …

Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and Disclosure … I am a participant in a group health plan that provides treatment for anorexia as a mental health benefit. In accordance with the plan terms, my provider, on my behalf, requested prior authorization for a 30-day inpatient stay to treat my anorexia. The request was denied based on the plan’s determination that a 30-day inpatient stay is not medically necessary under the plan terms…. Can my plan, upon request, provide a summary description of the medical necessity criteria for both [mental health and substance use disorder (MH/SUD)] benefits and medical/surgical benefits that is written to be understandable for a layperson?”

(Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; U.S. Department of Health and Human Services [HHS]; and U.S. Treasury Department)