Mental Health Parity Interpretations and Clarifications

A Trio of Federal Agencies charged with interpreting the Mental Health Parity laws have determined that a plan cannot require pre-authorization of mental health treatments if the same requirement is not imposed on other non-mental health related procedures.

A plan may not, as a routine matter, approve significantly shorter stays for inpatient mental health and substance abuse treatment than it does for inpatient medical or surgical care, even if extensions of those stays are subject to review.

Plan sponsors should be aware of these interpretations of the rules not only in  regard to plan design, but with regard to their own (and their vendor’s) administrative practices.

Preventative Care Coverage Under Health Reform

Under Health reform, the following preventive care services are covered with no copays, deductibles or co-insurance percentages for group and individual plans in effect after Septmber 23, 2010  (Non-Grandfathered Plans) and must apply to all group and individual plans by 2014: :

All members

  • Yearly preventive medicine visits (Wellness visits)
  • All standard immunizations recommended by the American Committee on Immunization Practices

All members at an appropriate age or risk status

  • Screening for colorectal cancer, elevated cholesterol and lipids
  • Screening for certain sexually transmitted diseases and HIV
  • Screening and counseling in a primary care setting for alcohol or substance abuse, tobacco use, obesity, diet and nutrition
  • Screening for high blood pressure, diabetes and depression

Women’s health

Recently, the Department of Health and Human Services released new health plan coverage guidelines that will require health insurance plans to cover women?s preventive services without charging a copayment, coinsurance or a deductible effective for plans beginning or renewing Aug. 1, 2012, to now include:

  • Well-woman visits
  • Screening for gestational diabetes for all pregnant women
  • Human papilloma virus DNA testing for all women 30 years and older
  • Annual sexually transmitted infection counseling for all sexually active women
  • Annual counseling and screening for HIV for all sexually active women
  • FDA-approved contraception methods, sterilization procedures and contraceptive counseling
  • Breastfeeding support, supplies, and counseling, including costs for renting breastfeeding equipment
  • Domestic violence screening and counseling

The following guidelines were effective for plan years beginning on or after Sept. 23, 2010:

  • Screening mammography and evaluation for genetic testing for BRCA breast cancer gene
  • Screening for cervical cancer including Pap smears
  • Screening for gonorrhea, Chlamydia, syphilis
  • Screening pregnant women for anemia, iron deficiency, bacteriuria, hepatitis B virus, Rh incompatibility
  • Promotion of and counseling for breast-feeding
  • Osteoporosis screening (age 60 and older)
  • Counseling women at high risk of breast cancer for chemoprevention

Men’s health

  • Screening for prostate cancer for men (age 40 and older)
  • Screening for abdominal aortic aneurysm in men (age 65-75)


  • Screening newborns for hearing, thyroid disease, phenylketonuria and sickle cell anemia
  • Standard metabolic screening panel for inherited enzyme deficiency diseases
  • Counseling for fluoride treatment
  • Screening for major depressive disorders
  • Vision screening
  • Screening for developmental/autism screening
  • Screening for lead and tuberculosis
  • Counseling for obesity

In addition to these services, under the Preventive Benefit, UnitedHealthcare also provides screening using CT colonography, Prostate-Specific Antigen (PSA), and screening mammography without age limits.

Supreme Court to Hear Health Reform Arguments

The Supreme Court said on November 14th it will hear arguments next March regarding President Barack Obama’s health care overhaul.

Their final ruling could shape the outcome for Obama’s re-election as this decision to hear arguments in the spring sets up an election-year showdown over the White House’s main domestic policy achievement.

The justices announced they will hear an extraordinary five-and-a-half hours of arguments from lawyers on the constitutionality of a provision at the heart of the law and three other related questions about the act. The central provision in question is the requirement that individuals buy health insurance starting in 2014 or pay a penalty.

It is possible that whatever the Court decides, the debate may not end.  It may possibly take more time to determine if the final responsibility for health care lies with the individual or government.

Even if the court upholds the law, Republican leaders say “repeal and replace” remains their slogan. “Job-killing tax hikes on families and small businesses may well be constitutional — that doesn’t mean we would support them,” said Senate Republican Leader Mitch McConnell of Kentucky.

The 2010 health care overhaul law aims to extend insurance coverage to more than 30 million Americans, through an expansion of Medicaid, the requirement that individuals buy health insurance starting in 2014 or pay a penalty and other measures. The court’s ruling could decide the law’s fate, but the justices left themselves an opening to defer a decision if they choose, by requesting arguments on one lower court’s ruling that a decision must wait until 2015, when one of the law’s many deferred provisions takes effect.

D.C. Court of Appeals Upholds Health Care Reform Requirement

      The District of Columbia  Circuit Court of Appeals today upheld the health care reform law’s         requirement that nearly all Americans buy insurance by 2014 or face penalties.    This ruling comes   just days before the Supreme Court is expected to consider whether to take up the  issue. That decision could come as soon as Thursday, when the justices will hold a private conference to discuss what cases to take this term.

The D.C. Circuit is now the second appeals panel to uphold the health reform law’s individual mandate. The law’s supporters are declaring victory because the opinion was written by a conservative judge, Laurence Silberman, who was nominated by former President Ronald Reagan. Silberman and Senior Judge Harry Edwards, who was nominated by former President Jimmy Carter, upheld a lower court ruling that the law was constitutional.  Judge Brett Kavanaugh, who was appointed by former President George W. Bush, dissented.

The D.C. Circuit Court is the fourth appeals panel to consider a lawsuit challenging the health reform law. The 6th Circuit upheld the law, the 11th Circuit struck the mandate and the 4th Circuit ruled that the Anti-Injunction Act which says Americans have to pay a tax before they can challenge it in court barred it from ruling on the mandate until at least 2014.

Part B 2012 Medicare Premiums Announced

The Department of Health and Human Services (HHS) has announced that Part B premiums for Medicare beneficiaries will rise to $99.90 in 2012, an increase of $3.50 over the 2011 cost. This was far lower than the anticipated increase of $106.00 per month.

Part B pays for physician visits, hospital outpatient costs and certain other services.

Officials attributed the lower than expected premium increase to several factors, including lower-than-expected use of medical care and slower cost growth.

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