Primary Focus: Parity: General Agency: The Department of Health Title/Description: Mental Health Parity and Addiction Equity Act Compliance Plan Citation: The report is available here. Summary: Mental Health Parity and Addiction Equity Act Compliance Plan: Louisiana Parity Analysis report prepared by the Louisiana Department of Health; Office of Behavioral Health. Release Date: December 2, 2017 Notes: N/A
Primary Focus: Parity: General Agency: The Department of Health and Hospitals, Bureau of Health Services Financing Title/Description: Benefits and Services Citation: LAC 50:I.10103, as created by LR 42:756 Summary: Minimum Essential Health Benefits. Pursuant to § 1302(b) of ACA, the ABP must provide the new adult group with a benchmark benefit or benchmark-equivalent benefit package that includes the required minimum essential health benefits (EHBs) provided in affordable insurance exchanges. There are 10 benefit categories and some of the categories include more than one type of benefit. The following services are considered EHBs:
mental health and substance use disorder services, including behavioral health treatment:
these services shall be in accordance with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008;
The Louisiana Department of Insurance (LDI) issued a bulletin(pdf | Get Adobe® Reader®) about the Department’s authority to enforce the Federal Parity Law and the Affordable Care Act (ACA). Pages 1 through 3 are relevant to parity. It informed plans that LDI would be monitoring all relevant plans for compliance with the Federal Parity Law and the ACA. Any plans that were found non-compliant would be issued a notice of non-compliance and asked to change their policies so that they abide by these federal laws. If there was continued non-compliance, LDI would refer any plan to the Center for Medicare and Medicaid Services (CMS) for further disciplinary action.
The bulletin also stated that LDI would respond to and investigate any consumer complaints related to the Federal Parity Law and the ACA. The LDI would request that any plan that was violating these laws should adjust their actions to resolve the issue. Any plan that “refuses to take corrective action” would be referred to CMS for further action. If any complaints or investigations reveal a pattern of violations, LDI and CMS would discuss the possibility of performing market conduct examinations. The bulletin also declared that LDI would assess any plan’s compliance with the Federal Parity Law and the ACA whenever LDI performs a market conduct examination.
Pages 4 through 10 contained information relevant to the ACA, but not relevant to parity.
Louisiana Parity Law
There are several sections of the state insurance law relevant to parity. They will be summarized below in this order (with appropriate hyperlinks to state law):
Plans cannot use annual maximums and lifetime maximums for mental health services if they aren’t in place for other medical services. If a plan does have these in place for other medical services, they can do either of the following:
Make it so that both behavioral health services and other medical services count towards combined maximums OR
Make the maximums for mental health services no less than the ones in place for other medical services
For plans that have many different maximums for different categories of medical care, the law requires plans to use a mathematical formula involving the weighted averages these annual and lifetime maximums to decide what the limits and maximums should be for mental health services.
Plans are exempt from this section if complying with it causes premium costs to increase by 1% in any year.
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