mental

Measuring the plan benefit was elaborated in the interim final rule, the main purpose of this was to determine the compliance with the general parity rule. Each financial requirement within a coverage unit must be analyzed separately within each benefits classification. The IFR states that the portion of plan payments subject to a financial requirement is based on the dollar amount of all plan payments for medical/surgical benefits in the classification that are expected to be paid for in the plan year. Generally health plans cannot split a benefits classification into sub- classifications when applying parity standards under MHPAEA. The IFR provides that a health plan is still in compliance with MHPAEA if the health plan applies different levels of financial requirements to different tiers of prescription drug benefits based on reasonable factors such as cost, efficacy, generic versus brand name, and so forth. Without regard to whether the drug is generally prescribed for medical/surgical or MH/SUD treatments (Melek Steve, n.d).
The MHPAEA has been in effect since the year 2009 but the interim final regulations went into effect for plan in the beginning of the year 2010, the plan would be initially be held to a “good faith compliance effort until the regulation went into effect”. ERISA contains no specific penalty or execution rule for violations of the MHPAEA. However, beneficiaries, and the DOL may use ERISA's civil enforcement provisions to file lawsuits to enforce the MHPAEA's requirements. The lawsuit could include claims for fissure of the fiduciary duty, failure to comply with the MHPAEA, as well as claims for payment of mental health benefits alleged to be due under the plan because the MHPAEA. The affected party could s...

... middle of paper ...

...ta.samhsa.gov/ health-reform/parity.
"Mental Health Parity and Addiction Equity Act (MHPAEA) -- Other Fed Mandate." Benefit Insurance Wealth Management. http://www.nfpbenefitspartners.com/ NFP_DA_Financial_Group_Of_California/hr/Other_Federal_Mandates/MHPAEA.aspx.
Module 1: Introduction to Global Mental Health: Effects of Mental Health on Individuals and Populations. Introduction to Global Mental Health: Effects of Mental Health on Individuals and Populations. Retrieved from http://www.uniteforsight.org /mental-health/module1
Module 6: Barriers to Mental Health Care. Barriers to Mental Health Care. Retrieved from http://www.uniteforsight.org/mental-health/module6
"NAMI - The National Alliance on Mental Illness." NAMI: National Alliance on Mental Illness.http://www.nami.org/Template.cfm?Section=Parity1&template=/ContentManagement/ContentDisplay.cfm&ContentID=102919.