1. Mental Health Parity and Addiction Equity Act (MHPAEA) Access to Tobacco Cessation Services May 19-20, 2014 Warren Ortland Staff Attorney Tobacco Control Legal Consortium

2. The Tobacco Control Legal Consortium A national legal network supporting tobacco control policy change.

3. Tobacco Law Centers California Minnesota Michigan Massachusetts Maryland New York

4. Who We Serve: Public health advocacy organizations and community coalitions Public health officials Elected officials City and county attorneys Private attorneys and individual citizens

5. What We Do: Policy development Litigation support Legal research, analysis, and interpretation Education and training

6. Paul Wellstone & Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)

7. Mental Health Parity Legislation Mental Health Parity Act (1996) Mental Health Parity and Addiction Equity Act (2008) MHPAEA Interim Final Rule (2010) Patient Protection and Affordable Care Act (ACA) (2010) MHPAEA Final Rule (2013)

8. Mental Health Parity Does not require that coverage be offered for any particular mental health condition or substance use disorder Essential Health Benefits (10 categories) Mental Health and Substance Use Disorders Service Nicotine Addiction

9. Mental Health Parity Requires certain medical plans that cover mental health or substance use disorders to offer coverage for those services that is similar to coverage for medical / surgical benefits

10. Mental Health Parity “Comparable to” & “No more restrictive than” 1.Is the limitation applied to substantially all medical/surgical benefits 2.Is it the predominant treatment limitation 3.Is it more restrictive for MH/SUD benefits than for medical/surgical

11. Mental Health Parity “Comparable to” & “No more restrictive than” Example: –A plan has a “prior authorization” requirement for MH/SUD, but not for medical / surgical benefit –The plan violates the MHPAEA because the offering of MH/SUD services cannot be more restrictive than those for medical / surgical

12. Mental Health Parity Six Classifications used to apply law 1.Inpatient, in-network 2.Inpatient, out-of-network 3.Outpatient, in-network 4.Outpatient, out-of-network 5.Emergency care 6.Prescription drugs

13. Mental Health Parity Parity within and across classifications Inpatient, in-network Medical/SurgicalMH/SUD Outpatient, out-of-network MH/SUD

14. MHPAEA Tobacco Cessation Treatment for nicotine addiction does not have to be offered in a plan, but if offered: Should be offered across all plan classifications Limitations for nicotine addiction treatment should be comparable to those for medical / surgical conditions

15. Mental Health Parity Quantitative / Non-quantitative limitations Quantitative Frequency of treatment Number of visits Days of coverage Non-quantitative Medical management standards Formulary design Determination of usual/customary/reasonable MH/SUD

16. MHPAEA – Plans Covered Employer funded 50+ employees Non-grandfather employer funded plans with 50 or fewer employees Medicaid managed-care plans Children’s Health Insurance Plans Medicaid Alternative Benefits Plans

17. MHPAEA – Plans NOT Covered Small employer plans created before 2010 Church-sponsored plans Self-insured plans for state and local government Retiree-only plans TriCare Medicare Traditional Medicaid X

18. MHPAEA Impact Between 2007 and 2011, mental health and substance use admissions increased Per capita spending on these admissions increased faster than spending on medical surgical Role of MHPAEA on this trend is not clear because of other possible contributing factors

19. MHPAEA Implementation Dates New regulations effective Jan. 13, 2014 Mental health parity provisions of final rule apply to plan years beginning on or after July 1, 2014. In interim, plans adhere to provisions of interim final rule.

20. MHPAEA Enforcement General Questions and Comments Department of Health and Human Services; Centers for Medicare and Medicaid Services Health Insurance Helpline 1-877-267-2323 Email CMS Helpline: phig@cms.hhs.gov Department of Labor 1-866-444-3272

21. MHPAEA / Cessation Resources The Mental Health Parity and Addiction Equity Act and the Affordable Care Act: Implications for Coverage of Tobacco Cessation - http://www.publichealthlawcenter.org/sites/default/files/resourc es/tclc-fs-mhpaea-&-aca-2014_0.pdf The Mental Health Parity and Addiction Equity Act: Key Elements and Implications for Smoking Cessation Therapies - http://www.ttac.org/tcn/peers/pdfs/10.26.10- B/SD_VCP01540_MHPAEA_White_Paper_Long.pdf

22. Contacts Tobacco Control Legal Consortium www.tclconline.org Maggie Mahoney (651) 290-7514 maggie.mahoney@wmitchell.edu Public Health Law Center www.publichealthlawcenter.org Warren Ortland (651) 290-7539 warren.ortland@wmitchell.edu