Mental Health Parity. The Contractor and its providers must comply with the Mental Health Parity and Addiction Equity Act of 2008, including the requirements that treatment limitations applicable to mental health or substance use disorder benefits are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the Contractor and there are no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits.
Mental Health Parity. 15.1 Humana and Hospital must comply with applicable requirements of the Mental Health Parity and Addiction Equity Act of 2008 and 42 C.F.R. 438 Subpart K, including the requirements that treatment limitations applicable to mental health or substance abuse disorder benefits are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by Humana and there are no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits.
Mental Health Parity. Contractor shall adhere to CMS guidelines regarding Mental Health Parity in accordance with 42 CFR Part 438, Subpart K detailed below and comply with the Mental Health Parity reporting requirements specified in Sec. 25 of Ex. M of this Contract:
a. If Contractor does not include an aggregate lifetime or annual dollar limit on any medical/surgical benefits or includes an aggregate lifetime or annual dollar limit that applies to less than one-third of all medical/surgical benefits provided to Members, it may not impose an aggregate lifetime or annual dollar limit, respectively, on mental health or substance use disorder benefits;
b. If Contractor includes an aggregate lifetime or annual dollar limit on at least two-thirds of all medical/surgical benefits provided to Members, it must either apply the aggregate lifetime or annual dollar limit both to the medical/surgical benefits to which the limit would otherwise apply and to mental health or substance use disorder benefits in a manner that does not distinguish between the medical/surgical benefits and mental health or substance use disorder benefits; or not include an aggregate lifetime or annual dollar limit on mental health or substance use disorder benefits that is more restrictive than the aggregate lifetime or annual dollar limit, respectively, on medical/surgical benefits;
c. If Contractor includes an aggregate lifetime limit or annual dollar amount that applies to one-third or more but less than two-thirds of all medical/surgical benefits provided to Members, it must either impose no aggregate lifetime or annual dollar limit on mental health or substance use disorder benefits; or impose an aggregate lifetime or annual dollar limit on mental health or substance use disorder benefits that is no more restrictive than an average limit calculated for medical/surgical benefits in accordance with 42 CFR § 438.905(e)(ii);
d. Contractor shall not apply any financial requirement or treatment limitation to mental health or substance use disorder benefits in any classification that is more restrictive than the predominant financial requirement or treatment limitation of that type applied to substantially all medical/surgical benefits in the same classification furnished to Members (whether or not the benefits are furnished by Contractor);
e. If a Member is provided mental health or substance use disorder benefits in any classification of benefits (inpatient, Outpatient, emergency care, or prescription drugs), men...
Mental Health Parity. Effective January 1, 2007, Swedish's self insured benefit plans shall include mental health benefits that are at least equal to the terms and conditions of member health benefits as mandated by the Mental Health Parity Law of 2005, substitute House Xxxx 1154. LETTER OF UNDERSTANDING
Mental Health Parity. Effective January 1, 2007, Swedish's self-insured benefit plans shall include mental health benefits that are at least equal to the terms and conditions of member health benefits as mandated by the Mental Health Parity Law of 2005, substitute House Xxxx 1154.
(a) if Swedish Medical Center builds or opens a new facility and Swedish Medical Center is the legal employer of the employees, the employees at that facility who perform the same or similar work to that which is covered by this Agreement will be covered by the terms of this Agreement and will be included in the bargaining unit covered by this Agreement;
(b) if Swedish Medical Center acquires an existing operation and some of the employees at that facility are represented by SEIU Healthcare 1199NW, then all such employees at that facility who perform the same or similar work to that which is covered by this Agreement will be covered by the terms of this Agreement and will be included in the bargaining unit covered by this Agreement if the acquired operation is in King, Snohomish, or Xxxxxx, County. The parties will promptly meet to bargain the terms and conditions of employment of employees at that facility who are represented by SEIU Healthcare 1199NW who do not perform the same or similar work to that which is covered by this Agreement. In the event the acquired operation is located elsewhere, Swedish Medical Center agrees to immediately recognize SEIU Healthcare 1199NW as the representative for the employees already represented by the Union, and will promptly meet to bargain the terms of employment for covered employees;
(c) if Swedish Medical Center acquires an existing operation and some of the employees at that facility are represented by another union or are unrepresented, the Employer will cooperate fully with the Union to determine promptly and efficiently whether accretion is appropriate under established principles of labor law, and if so, to effectuate it. Following an accretion the parties will promptly meet to bargain any outstanding issues;
(d) if Swedish Medical Center acquires an existing operation and some of the employees at that facility are represented by another union or are unrepresented and an accretion is not appropriate, the parties agree to be bound by the Neutrality Agreement below. In the event the Union files a representation petition with the NLRB, Swedish Medical Center will agree to have the case processed through the NLRB Consent Election procedures;
(e) The preceding...
Mental Health Parity. 2.3.11.1 The Contractor shall comply with the Xxxx Xxxxxxxxx and Xxxx Xxxxxxxx Mental Health Parity and Addiction Equity Act of 2008, which requires parity between mental health or substance use disorder benefits and medical/surgical benefits with respect to financial requirements and treatment limitations. The Contractor shall comply with all requirements set forth in 42 C.F.R. Part 438 Subpart K, for all Medicaid managed care enrollees.
2.3.11.1.1 The Contractor must comply with parity requirements for aggregate lifetime or annual dollar limits on mental health or substance use disorder benefits, including prescription drugs as specified in 42 C.F.R. §438.905.
2.3.11.1.2 All financial requirements or treatment limitations, including nonquantitative treatment limitations (NQTL), to mental health or substance use disorder benefits shall not be more restrictive than the predominant financial requirement or treatment limitation applied to substantially all medical/surgical benefits, in accordance with 42 C.F.R. §438.910. Financial requirements cannot accumulate separately for medical/surgical benefits and mental health/SUD benefits.
2.3.11.2 The Contractor shall develop and maintain internal controls to ensure mental health parity. The Contractor’s utilization practices such as prior authorization, standards for medical necessity determination, and network policy, procedures, and practices shall comply with the federal regulations referenced above.
2.3.11.2.1 The Contractor shall conduct an initial parity analysis as part of its readiness review process and at other times as directed by LDH, based on benefit classifications for parity as defined by LDH. If an enrollee is provided mental health or substance use disorder benefits in any classification of benefits, mental health and substance use disorder benefits must be provided to the enrollee in every classification in which medical/surgical benefits are provided.
2.3.11.2.2 The Contractor shall cover, in addition to State Plan required services, any service necessary for compliance with the requirements for parity in mental health and substance use disorder benefits based on parity analysis. As directed by LDH as part of ongoing parity review, the Contractor may be required to cover or change services necessary for compliance including type and amount, duration and scope of services and change policy or operational procedures in order to achieve and maintain compliance with parity requirements.
2.3.11.2.3 ...
Mental Health Parity. Claim Administrator has or will timely establish processes and procedures, in accordance with sound professional practices and prevailing industry standards, reasonably necessary for Claim Administrator to timely support good faith requests of Employer for data or other documentation that Employer may need to analyze and document the Plan’s compliance with applicable Mental Health Parity requirements, including amendments to Mental Health Parity and Addiction Equity Act (“MHPAEA”) of 2008. So long as Employer has elected to implement Claim Administrator’s standard non- quantitative treatment limitations (“NQTLs”) and so long as Claim Administrator administers both mental health/substance abuse benefits and medical/surgical benefits on behalf of Employer, this may include applicable comparative documentation with respect to Claim Administrator’s administered NQTLs under the Plan which may be necessary for addressing and complying with the requirement to analyze and document NQTL parity between mental health/substance abuse benefits and medical/surgical benefits, as required by Division BB, Title II, Section 203 of the CAA and guidance issued thereunder. In addition, in the event that the U.S. Department of Labor or other regulatory agency (“Agency”) with competent jurisdiction over the Plan initiates an audit or other assessment related to the Plan’s compliance with mental health parity requirements, including the obligation to perform and/or make available the comparative analyses described above, Claim Administrator agrees to provide expedited support to enable Employer and the Plan to timely provide documentation requested by the Agency. Both Parties agree and understand that no data or other documentation provided by Claim Administrator under this Section shall be reasonably interpreted as a certification of the compliance of the Plan or any Claim Administrator’s administered NQTLs or other processes with State or Federal Mental Health Parity requirements. Employer agrees that compliance of the Plan with such requirements is solely the responsibility of Employer.
Mental Health Parity. Contractor may cover, in addition to services covered under the State Plan, any services necessary for compliance with the requirements for parity in mental health and substance use disorder (MH/SUD) Benefits in 42 C.F.R. part 438, subpart K and 42 C.F.R. section 457.496 (as appropriate to the Enrolled Member), and the Contract identifies the types and amount, duration and scope of services consistent with the analysis of parity compliance conducted by either the State or the MCO. See: 42 C.F.R. § 438.3(e)(1)(ii); 42 C.F.R. § 457.1201(e). {From CMSC F.6.15}. F.6.32. Contractor may cover services or settings for Enrolled Members that are in lieu of those covered under the State Plan if:
Mental Health Parity. Provider shall comply with the Mental Health Parity and Addiction Equity Act of 2008 and 42 C.F.R. 438 Subpart K, including the requirements that treatment limitations applicable to mental health or substance use disorder benefits are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the Contractor and there are no separate treatment limitations that are applicable only with respect to mental health or substance use disorder benefits.
Mental Health Parity. Provider shall cooperate with Health Plan’s Mental Health Parity and Addiction Equity (MHPAEA) policies and procedures and shall not discriminate against Covered Persons requiring mental health and/or addiction services. (SC App. B §8)
