Federal Mental Health Parity: What You Need to Know Small Business 2-99.

Federal Mental Health Parity:

What You Need to Know Small Business 2-99

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Discussion Topics

•What is Federal Mental Health Parity Addiction & Equity Act (FMHPAEA)

•Federal Legislation 101 & UHC’s approach

•What is happening for impacted groups

• The ‘employs 50’ rule

• General guidelines

•Documentation

• Contracts

• Benefit Summaries,

• Addendum Tool

•Sales Involvement

•Case Installation Requirements


What is Mental Health Parity?

In late 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law. This law updated the existing mental health parity laws by now applying them to both Mental Health and Substance Use Disorder benefits (MH/SUD). The Interim Final Rule was published February 2, 2010, implementing the MHPAEA (the “Rule”).

This new Rule requires that the treatment limitations applied to mental health and substance use disorder benefits be no more restrictive than those applied to a customer’s medical/surgical benefits.

It is now a requirement that one deductible and out of pocket maximum limit cover all medical and MH/SUD services. It is no longer allowed to have separate but equal deductibles and out of pocket limits applying to the medical and the MH/SUD services.

The Rule affects all groups that employ 51 or more people. The Rule goes into effect with all new and renewing customers groups as of 7/1/2010.


High Level Overview

Federal Mental Health Parity Addiction Equity Act applies to new and renewing customers as of July 1, 2010, that EMPLOY more than 50 persons: this count includes part time and seasonal employees for purposes of this Federal legislation.

General Provisions—Benefit Plans:

• Must have shared deductibles between medical and behavioral. It is no longer permissible to have separate but equal deductibles.

• Must have shared out of pocket maximums between medical and behavioral. It is no longer permissible to have separate but equal out of pocket maximums.

• Must remove any day limits under inpatient behavioral services unless there are the same limits applied to the medical/surgical inpatient hospital stay.

• Must remove any visit limits under outpatient behavioral services unless there are the same limits applied to the medical/surgical benefits – Physician Office Services/Sickness and Injury

• Must apply same non-quantitative treatment limitations to behavioral services as that are applied to medical/surgical benefits. This includes prior authorization, medical management. any penalty for lack of following prior authorization requirements, etc.

• Must apply the 2/3rd rule for medical/surgical costs before the behavioral health cost share can be determined. This step has been completed by Actuary for SB plans and is included in the addendums.


General Guidelines on plan design changes

•The “Substantially All” - 2/3’s rule: “tests” each financial requirement (e.g., copay, deductible, coinsurance) to see whether that requirement applies to “substantially all” medical/surgical benefits (2/3 or more) within the specific classification of benefits: Inpatient INN, Outpatient INN, Inpatient OON, Outpatient OON, and ER. (The “substantially all” test for Prescription Drug is one of reasonability. See next slide for details.)

• If a type of financial requirement or treatment limitation does not apply to “substantially all” medical/surgical benefits in that classification, it cannot be applied to Mental Health or Substance Use Disorder.

• 2007/09: If plan has OV copay and cost sharing for all other office based services, then outpatient MH/SU services will be 100% - no ded, no copay. Does not pass 2/3 rule.

• 2007/09: If plan is ded/coins – then outpatient MH/SUD services will remain at ded/coins. Passes 2/3 rule.

• 2001/02: If plan has OV copay and outpatient Surgery copay – then MH/SUD services will remain at Specialist copay. Passes 2/3 rule

• 2001/02: If plan has a OV copay (no outpatient Surgery copay) – then MH/SUD services will be no cost share. Does not pass the 2/3 rule.


Federal Rules on Group Size—SB Change

For purposes of Federal Mental Health Parity, groups with over 50 TOTAL employees need to comply with the legislation

•TOTAL employee count includes:

• Full time,

• Part time,

• Seasonal/temporary employees

• Employees in the waiting period.

Does not include 1099 employees

•Letter to Brokers is being sent to advise them of this change and to let them know employer letters are being sent.

•Employer Letters are being sent to 2-50 size groups starting with July, 2010 renewals

• Letters will be sent directly for July, August and some September renewals. Goal will be to include the letter in the renewal package going forward.

• Letters are being sent across all platforms

Special communication with both letters and an FAQ is being sent to all SB Sales Staff


New Business

For New Groups effective 7-01-2010

• If a group has more than 50 total employees, the appropriate benefits consistent with their plan design will be added to the group—no plan code change, no rate change. Benefit cost will be included in medical trend going forward.

• The Employer Group Application and the New Business Cover Sheet will used by Case Install using TOTAL number of employees to assure compliance.


Renewals

For SB Renewals July, August and September letters will be sent to 2-50 employers asking for verification of total employees.

• The letters are going out for all platforms and will each contain unique fax number and contact information

Beginning in September for Prime based business renewals, the letter will be included in the renewal package.

For groups that have more than 50 TOTAL employees, the appropriate mental health benefits will be added to their benefit plan—no plan code change, no rate change but the additional benefits will be included in medical trend going forward.


Fully Insured Impact – Groups 2-99

•FMHP DOES apply if the group employs more than 50.

• We will be reaching out to Brokers and employers via a letter asking them to acknowledge if they meet the federal definition of a large group for purposes of mental health benefits.

•Since most current 2-50 groups will not be subject to this Act, there will be no change in overall benefit plan design, codes or names. The mental health/substance use benefits will be updated within current plans through a rider as follows:

•The mental health/substance use benefits will be updated as follows:

• Day limits will be removed, if required

• Visit limits will be removed, if required

• Prior authorization penalty will change to 50% of eligible expenses to match that of medical to support the nonquantitative treatment limitation requirement

• In many instances the member’s Network outpatient mental health/substance use copay will change to have no cost share to meet the 2/3rd requirement <see slide 5 for definition of 2/3rd rule>

• Continue to have shared deductibles between medical/surgical and mental health

• Continue to have shared out of pocket maximums between medical/surgical and mental health

•If the customer meets this ‘employs more than 50’ criteria and the GA/Broker adds the group online via UeS, there will be two new optional riders they will need to select in order for the federally qualified employer group to get the appropriate behavioral benefits.

• UeS has been updated with two new medical optional riders. Those optional riders are Mental Health Parity 2 and Mental Health Parity 2 TEO50 (total employees over 50). These 2 options are for the revised Mental Parity effective 7/1/10 to identify groups with less than 51 eligible employees but more than 50 total employees. If that is the case, both options should be selected. If not, neither option should be selected.


UeS Screenshot for Mental Health Riders


What’s happening behind the scenes for all impacted groups?

Phase 1 – already completed (10/3/09)•No change in benefit plan design CODES or NAMES for UNET

•Created benefit summary addendums for the impacted plan designs or updated state specific benefit summaries

•Removal of day and visit limits for groups 51+

•Federal Notice was updated to incorporate new requirements

•Phase 2- happening NOW and will be completed by 7/1/2010•Creating benefit summary addendums for the impacted plan designs

•For 51+ plan designs, removing mental health limits to achieve compliance, for groups ‘employing 50’ adding a rider to remove mental health limits (claims perspective only)

•Changing mental health benefits to be parity compliant within in our claims systems

• Federal Notice will be updated to incorporate new requirements


Federal Definition of a Small Group Mailings

National SB Sales Leadership call—May 21

Letters to Brokers –May 27

Letter to Employers—first phase (July and August renewals) direct letter for groups 20+ May 28, 2010

Letter to Employers included in all 2-50 renewal packages September, 2010 to June 2011)

Mental Health Parity changes for new business and renewals effective 7-2010


Addendum Tool for Benefit Summary Information


Introduction

The Federal Legislation Benefit Summary Addendum Website was developed to locate the correct Federal Legislation Benefit Summary Addendum for the user based on the current status of the states Benefit Summaries. This website addendum’s support both Pre-2007 and 2007 COC Series.

• Not all Benefit Summaries have been revised to include the October 2009 and July 2010 Federal Legislation benefit and language changes.

• To support the October 2009 and/or July 2010 Federal Legislation benefit and language changes, over 40 Benefit Summary Addendum’s have been created.

The user will enter some basic information regarding the plan design that was sold into the website page and the correct Federal Legislation Benefit Summary Addendum and Print Care Code will be displayed.

If the Benefit Summary includes the October 2009 and July 2010 Federal Legislation benefit and language changes, a message that an Addendum is not required will display on the website.


The Addendum Tool

Addendum Tool: http://webe0065/FLA/ Tool can be accessed 2 ways: On Demand Template Website

PAG Fed Leg website User Guide available on website


Website Instructions

To search for a Benefit Summary Addendum, go to the Federal Legislation Benefit Summary Addendum website located at the following address:

http://webe0065/FLA/

The following page will display:


Website Instructions

Using the drop down box, select the correct Funding Arrangement.

Since we have different Addendums for Self Funded vs Fully Insured, this allows us to provide a copy of the correct Addendum.


Website Instructions – Fully Insured

Using the Drop Down box, select whether the plan design sold is from the 2007 COC Series or Pre-2007 (which would include COC series between 2001–2005)


COC Series 2007 Website Instructions – Fully Insured

If the COC Series of 2007 was selected the following screen and questions will display. By answering all of the questions on this page, the correct Federal Legislation Benefit Summary Addendum will display.


COC Series 2007 Website Instructions – Fully Insured

The Print Care Code and Addendum PDF file will display on the bottom of the page.

To view and/or print the addendum press:

View Addendum


COC Series Pre-2007 Website Instructions – Fully Insured

If the COC Series of Pre-2007 was selected the following screen and questions will display. By answering all of the questions on this page, the correct Federal Legislation Benefit Summary Addendum would display for the Pre-2007 Plan Design/Benefit Summary.


COC Series Pre-2007 Website Instructions – Fully Insured

The Print Care Code and Addendum PDF file will display on the bottom of the page.

To view and/or print the addendum press:

View Addendum


Addendum Naming Convention

Fully Insured Addendum Naming Convention

1st field = Funding Arrangement FI = Fully Insured

2nd field = Addendum Version B = Ben Sum's have not been revised with Oct 2009 or July 2010 language.C = Ben Sum's have been revised with Oct 2009, but not July 2010 language.

3rd field = Business Segment KA = Key Account. SB = Small Business

4th field = Type of Product NET = Network only benefits (Choice & Select products)PLUS = Network and Non-Network Benefits (Choice Plus, Select Plus, Options PPO and Non-Diff PPO products)

5th field = OP MH Benefit Indicates what type of Outpatient MH benefits the Addendum supports

6th field = IP MH Benefit Indicates what type of Inpatient MH benefits the Addendum supports

Definitions for OP and IP fields:

100% = Paid at 100%, no Deduct

DEDCOINS = Paid at Coinsurance and Deductible

COPAY = Paid at IP Hospital Copayment or Physician Office Service CopaymentSelf-Funded Addendum Naming Convention

1st field = Funding Arrangement ASO = Self Funded

2nd field = Type of Product NET = supports Choice product. PLUS = supports Choice Plus product

3rd field = Business Segment Fed-Leg_Ben_Sum_Addendum

4th field = Type of Product PPO = supports Options PPO product


Addendum Inventory and Naming

Over 40 Addendums have been created to support the different Funding Arrangements, Business Segments, COC Series, Product Types and Plan Designs:

• One set of addendums were created for when a states benefit summaries have not been revised with the Federal Legislation October 2009 language or July 2010 language – these are called Addendum B.

• A different set of addendums were created for when a states benefit summaries have been revised with the Federal Legislation October 2009, but not the July 2010 language – these are called Addendum C.

• If the Benefit Summaries have been updated with the Federal Legislation October 2009 and July 2010 language, a message will display indicating that an Addendum is not needed.

Addendum Naming Convention Small Business

FI_C_SB_PLUS_DEDCOINS_DEDCOINS

This naming convention represents a Fully Insured, Small Business, Network/Non-Network Benefit Summary Addendum that pays the OP MH and IP MH benefits at the plans Coinsurance and Deductible.

This Addendum supports a states benefit summary that has been revised with the Federal Legislation October 2009 language, but not the July 2010 language.


Addendum Example: Page 1 of 2FI_C_SB_PLUS_DEDCOINS_COPAY

FI_C_SB_PLUS_DEDCOINS_COPAY

This Addendum supports:

Benefit Summaries that have been revised with the Federal Legislation October 2009, but not the July 2010 benefit and language changes.

Small Business Network/Non-Network plans.

Outpatient MH benefits are paid at the coinsurance and deductible.

Inpatient MH benefits that are paid using the Hospital Inpatient Stay Copayment.

PAGE 1 OF THE ADDENDUM


Addendum Example: Page 2 of 2FI_C_SB_PLUS_DEDCOINS_COPAY

FI_C_SB_PLUS_DEDCOINS_COPAY


Benefit Summaries that have been revised with the Federal Legislation October 2009, but not the July 2010 benefit and language changes.

Small Business Network/Non-Network plans.

Outpatient MH benefits are paid at the coinsurance and deductible.

Inpatient MH benefits that are paid using the Hospital Inpatient Stay Copayment.

PAGE 2 OF THE ADDENDUM


Addendum Example: FI_B_SB_NET_100%_DEDCOINS

FI_B_SB_NET_100%_DEDCOINS


Benefit Summaries that have been not been revised with the Federal Legislation October 2009 or July 2010 benefit and language changes.

Small Business Network only plans.

Outpatient MH benefits are paid at 100%, deductible does not apply.

Inpatient MH benefits that are paid at the coinsurance and deductible.


Sales – What do I need to do?

Nothing different

All of the changes will be happening behind the scenes.

Plan Designs Actuary and Product has reviewed the standard plan designs and have made the required

changes to make sure they are compliant.

Existing SB (51+) cases on PRIME will receive compliant benefits upon renewal.

Use addendum tool if client would like to see the compliant benefit detail at the Federal level.

For cases that have already confirmed renewal or new business sold for 7/1, we will go back and update benefits to be compliant. Date TBD as to when this will occur.

Be aware of the following:

Brokers and employer groups will be receiving a letter asking them to acknowledge group size if they employ more than 50 persons.

If a customer in the 2-50 size group meets the federal definition of a large group, their mental health benefits will be modified to comply with the federal mental health parity requirements.


Contracts- What the Customer will receive

Contract Issuance:

• To update the existing COC’s with necessary contract changes to comply with the enacted Federal Legislation, every state will be re-filed. The filing will follow the typical approval process. The amendment that will support the Federal Mental Health changes will be available only after state approval is received and system coding is completed.

• If customer has opted in to eCOC the document will be available on myuhc.com

• While securing state approval of the contract language, it is the expectation that benefits are quoted and administered according to both federal and state legislation.

• New customers receive COCs that are on file at the time of their effective date. COCs will not be retroactively issued.

Notification:

All new and renewing customers will receive the most recent Federal Notice.

• This notice will describe at a high level the requirements and Benefits for Mental Health Parity. The Federal Notice is not a filed form, rather than an addition to the COC. The Federal Notice summarizes benefit requirements and will be used in the interim for all impacted customers while UnitedHealthcare updates its current COCs. The revised Federal Notice will be in production with all new and renewing groups as of July 1 st. .

• Federal Notice will be sent via our standard contract delivery process.

No external communication is scheduled at this time to explain the change in the customers benefits but rather the benefit summaries and supporting addendums should be provided to the group.


SB Checklist for Mental Health Parity

Letter to SB employers on the new Federal definition of a large group for all July/August and some September renewals across all platforms:

•Brokers—May 27th

•Employers—May 28th-June 1

Standard letter included in UHC renewal package for 9-01-2010 renewals until 6-01-2011

For Groups that are 51+, new benefits will be added to be compliant for renewals and new business effective 7-01-2010 (no rate change or plan code change---new benefits will be included in overall trend)

Addendum tool available to Sales Staff to show the changes in an employer’s benefits by state and plan code—some plans will not be affected

New business will use the total number of employees from the group application to determine if Federal Mental Health Parity benefits apply.


Have Questions?

1. For Parity rules & UHC’s interpretation see Connect:

• Federal Mental Health Parity Interim Regulations (updated March 19, 2010) with the following attachments:

• The Mental Health Parity and Addiction Equity Act of 2008 (updated March 11, 2010)

• SB Connect Communication with FAQ—May 21, 2010

2. Field Contacts for Small Business--RDOs

Karen Finnerty—National

Sharon Carter—West Region

Christy Wooten—Central Region

Pam Williams—SE Region

Lorraine Butzke—NE/Mid-Atlantic Region

3. Regional Product contacts: Tracy Plunkett – West Region

Rich Nelson – Central Region

Tracey Durham – SE Region

Cathy Lang – NE/Mid- Atlantic Region

Federal Mental Health Parity: What You Need to Know Small Business 2-99.

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Transcript of Federal Mental Health Parity: What You Need to Know Small Business 2-99.