Primary Focus: Medicaid Agency: Department of Health and Human Services Title/Description: The Physical Health Managed Care Basic Benefits Package: Section 4-003.01: General Requirements Citation: 482 Neb. Admin. Code § 4-001 Summary: The health plan is required to comply with all applicable state and federal regulations, such as the prohibition against assisted suicide; inappropriate use of funds/profits, lack of mental health parity, and the noncompliance with the provisions of the Hyde Amendment. Effective Date: The new rule was effective October 16, 2017 and expires on October 24, 2024. Notes: N/A
Primary Focus: Insurance Agency: Nebraska Department of Insurance Title/Description: Nebraska Insurance Notices and Bulletins Summary: The bulletin discussed insurer obligations in complying with parity requirements stating:
“Insured large group plans, insured small group, individual market plans and student health plan forms are being reviewed for compliance with the regulations of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
The division is reviewing insured large group plans, insured small group, individual market plans and student health plan forms for compliance with the regulations of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
The Department’s review will include filed policies, certificates, and schedules.
Objections will be made to any plan design that imposes a financial requirement or quantitative treatment limitation applicable to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or quantitative treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification.”
If a plan uses a deductible, there must be only one deductible for both mental health services and other medical services.
Plans are explicitly allowed to use non-quantitative treatment limitations for mental health services and there is no language stating that they must be used similarly to how they are for other medical services.
If a plan does not cover mental health services, it must “provide clear and prominent notice of such non-coverage.”
These sections of the law define “basic coverage for treatment of alcoholism” if it covers 30 days of inpatient care for alcoholism treatment in any given year and 60 outpatient visits over the life of a policy. However, this section of the law does not require plans to provide this coverage and explicitly states that plans can provide lesser coverage.
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