Mental Health Parity and Addiction Equity Act Sample Clauses

Mental Health Parity and Addiction Equity Act. (MHPAEA)
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Mental Health Parity and Addiction Equity Act. ‌ You have rights to parity in mental health and substance use disorder treatment as required by the federal Mental Health Parity and Addiction Equity Act and Minnesota Statutes, section 62Q.47. These laws require that: • Mental health and substance abuse services covered on the same basis as medical services; • That cost-sharing for mental health and substance abuse services can be no more restrictive than cost-sharing for similar medical services; • That treatment restrictions and limitations such as prior authorization and medical necessity can be no more restrictive than for similar medical services; • That if enrollees have concerns they can call Member Services, file a complaint with HealthPartners, or file a complaint with Minnesota Department of Health.
Mental Health Parity and Addiction Equity Act. (MHPAEA)‌
Mental Health Parity and Addiction Equity Act. Notwithstanding anything in the Plan to the contrary, the Plan will comply with the Mental Health Parity and Addiction Equity Act and ERISA Section 712.
Mental Health Parity and Addiction Equity Act. (MHPAEA) Requirements. The MCOP must comply with MHPAEA requirements outlined in 42 CFR Part 438 Subpart K, with regard to services provided to managed care members. The requirements apply to the provision of all covered benefits and additional services (i.e., value-added and in lieu of services) to all populations included under the terms of this Agreement. a. The MCOP must participate in ODM requested meetings, respond to ODM information requests, work with ODM to resolve compliance risks, and notify ODM of any changes to benefits or limitations that may impact compliance with MHPAEA. b. The MCOP must conduct ongoing monitoring to determine compliance with MHPAEA and report compliance analysis and determinations using the MHPAEA Compliance Assessment Tool (MHPAEA Tool) provided and required by ODM. c. The MCOP must submit an updated MHPAEA Tool and written attestation of MHPAEA compliance to ODM: i. At least 30 calendar days prior to the proposed effective date for implementing any new clinical coverage policy or changes to previously approved clinical coverage policies; ii. At least 30 calendar days prior to the proposed effective date to apply a financial requirement (co-payment); iii. At least 30 calendar days prior to the effective date of a change to benefits or limitations that may impact MHPAEA compliance; iv. Annually, as specified in Appendix T, Chart of Deliverables; and v. Upon ODM’s request d. The MCOP’s annual updated MHPAEA Tool must include an annual summary of self-monitoring activities that describes: i. The MCOP’s process for reviewing and analyzing changes to benefit packages, service delivery structures, operational requirements, and policies to ensure ongoing parity compliance; and ii. The MCOP’s process for monitoring parity compliance in operation on a regular basis, including: 1. The data/information monitored by the MCOP to identify potential parity compliance concerns, the frequency of the MCOP’s review of the data/information; 2. How the MCOP determines when further analysis is necessary; and 3. The process used by the MCOP to conduct further analysis when the data/information suggests the possibility of a parity compliance concern. e. The MCOP will work with ODM to ensure all members are provided access to a set of benefits that meets the MHPAEA requirements regardless of which behavioral health services are provided by the MCOP.
Mental Health Parity and Addiction Equity Act. The Mental Health Parity and Addiction Equity Act provides for parity in the application of aggregate treatment limitations (day or visit limits) on mental health and substance abuse benefits with day or visit limits on medical and surgical benefits. In general, group health plans offering mental health and substance abuse benefits cannot set day/visit limits on mental health or substance abuse benefits that are lower than any such day or visit limits for medical and surgical benefits. A plan that does not impose day or visit limits on medical and surgical benefits may not impose such day or visit limits on mental health and substance abuse benefits offered under the Plan. Also, the Plan may not impose Deductibles, Copayment, Coinsurance, and out of pocket expenses on mental health and substance abuse benefits that are more restrictive than Deductibles, Copayment, Coinsurance and out of pocket expenses applicable to other medical and surgical benefits. Medical Necessity criteria are available upon request.

Related to Mental Health Parity and Addiction Equity Act

  • Health Insurance Portability and Accountability Act Grantee certifies that it is in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law Xx. 000-000, 00 XXX Parts 160, 162 and 164, and the Social Security Act, 42 USC 1320d-2 through 1320d-7, in that it may not use or disclose protected health information other than as permitted or required by law and agrees to use appropriate safeguards to prevent use or disclosure of the protected health information. Grantee shall maintain, for a minimum of six (6) years, all protected health information.

  • Family and Medical Leave Act of 1993 The parties agree that the Employer may adopt policies to implement the Family and Medical Leave Act of 1993 that are in accord with what is legally permissible under the Act.

  • Family and Medical Leave Act (FMLA In accordance with the Family and Medical Leave Act (FMLA) of 1993, the Board will grant a leave of absence for one or more of the following: 1. Because of the birth of a son or daughter of the employee, and in order to care for such son or daughter; 2. Because of the placement of a son or daughter with the employee for adoption or xxxxxx care; 3. To care for the employee's spouse, son or daughter, or par- ent, in laws or members of blended families or other per- sons in a similar relationship that live in the family house- hold or are in a similar family relationship who has a serious health condition; or, 4. The employee is unable to perform the essential job func- tions because of a serious health condition. As of February 2008, an employee who is the spouse, son, daughter, parent or the next of kin of a covered service mem- ber can take up to 26 weeks of FMLA leave during a single twelve (12) month period to care for the injured service mem- ber. The same eligibility requirements apply for employees requesting a leave under this category. Regulations as estab- lished by the Department of Labor will be followed when granting leaves under this provision. FMLA leaves are only available to employees who have been employed by the District for at least twelve (12) months and have worked 1,250 hours during the previous twelve (12) month period. Such leaves are counted against an employee's annual FMLA leave entitlement. Under the FMLA, an employee is eligible for a total of twelve (12) work weeks of leave in a twelve (12) month period. This twelve (12) month period is measured back from the date a requested leave is to begin. Continuation of medical, optical and dental benefits and the right to job restoration ceases when an employee has used twelve (12) work weeks of FMLA leave in the twelve (12) month period. (See Section B, Medical Leave of Absence). An employee requesting a FMLA leave must provide the Xxxxx- xxxx Superintendent of Human Resources at least thirty (30) days advance notice of when the leave is to begin. If such no- xxxx is not practicable, then notice is to be provided as soon as practicable. When a leave denoted as (1) or (2) above is granted, the leave must be taken in one (1) continuous increment, and must be concluded within twelve (12) months of the date of birth or placement. Employees granted such leave must utilize accu- mulated vacation days and accumulated personal business days (in that order), after which time the leave is unpaid. When a leave denoted as (3) above is granted, the employee must utilize accumulated sick leave time, accumulated vacation days, and accumulated personal business days (in that order), after which time the leave is unpaid. When a leave denoted as (4) above is granted, the employee must utilize accumulated sick leave days and accumulated per- xxxxx business days (in that order), after which time the leave is unpaid. After these days have been used and if more sick time is needed, the employee may choose to use accumulated vacation time. When additional time is needed during the 90 calendar day (13 week) LTD elimination period, the employee may use available vacation days. If the employee has pur- chased and is filing for short term disability, vacation days may be used during the 14 day elimination period. Vacation days cannot be used once the short term disability coverage starts. Leaves denoted as (3) or (4) above must be supported by med- ical certification from a health care provider stating (1) the date on which the serious health condition commenced, (2) the probable duration of the condition, (3) the appropriate medical facts, and (4) a statement that the employee is unable to per- form the essential functions of his/her position, or that the em- ployee is needed to care for the person. The District reserves the right to require the employee to obtain the opinion of a sec- ond health care provider designated or approved by the District concerning any information within the medical certification. When a FMLA leave denoted as (1) or (2) above is granted to spouses who are both employed by the District, the total amount of time on leave (in total for both employees) cannot exceed twelve (12) weeks of FMLA time. At the expiration of a medical leave or if the employee wishes to return to work before completion of the leave, there must be a physician's certification confirming his/her fitness to return to work. The District may condition the employee's return to work upon a fitness for duty examination and approval by a health care provider designated by the District. The District will continue to provide an employee's medical, optical and dental insurance while he/she is on a FMLA leave for a period of up to twelve (12) weeks on the same terms and conditions as prior to the leave. An employee on a FMLA leave shall not engage in any outside or supplemental employment. The District may recover insurance premiums paid while an employee was on an unpaid FMLA leave if: 1. The employee fails to return to work for at least thirty (30) days after the expiration of the leave; and 2. The failure to return is for a reason other than a serious health condition, or other circumstances beyond the control of the employee. Certification from the health care provider may be required for this purpose. An employee returning from a FMLA leave will be restored to the position he/she left, or to an equivalent position with equiv- alent benefits, pay and other terms and conditions of employ- ment. If the employee has not satisfactorily completed the probation- ary period at the commencement of a FMLA leave, then upon cessation of the leave, the employee must work the days need- ed to complete the probationary period.

  • Family and Medical Leave Act The Family and Medical Leave Act will be followed in approving a Leave of Absence. Contract provisions that provide greater benefits than the Family and Medical Leave Act will be followed.

  • Health Insurance Portability and Accountability Act of 1996 This paragraph was intentionally left blank.

  • Family and Medical Leave (FMLA FMLA leave shall be granted pursuant to applicable law.

  • Family Medical Leave Act 1. If an employee takes a leave granted under this Article for a reason covered by the Family and Medical Leave Act, the leave shall be administered under the provisions of the FMLA. 2. Upon approval of the Superintendent and Association President, this Section may be modified as necessary to comply with federal law and rules and regulations. 3. The Board shall provide a copy of the policy on FMLA in the library of each building.

  • Group Health Insurance The Employer shall provide a comprehensive health care insurance program for all permanent full-time and part-time employees. Health Plan characteristics and benefits shall be as provided in the Employer’s Agreement with the Ohio Civil Service Employees Association (hereinafter OCSEA). Regardless of the plan, employees will pay fifteen percent (15%) of the premium and the Employer will pay eighty-five percent (85%) of the premium; however for any alternative plans offered pursuant to the Agreement with OCSEA, the employees’ premium share will be determined by the Director of DAS, but will not exceed fifteen percent (15%) of the premium. The Employer’s premium share shall be paid on behalf of eligible employees as provided in the Employer’s Agreement with OCSEA. Employees who include a spouse as a dependent for healthcare coverage shall pay a surcharge as provided in the Employer’s Agreement with OCSEA. Eligibility provisions for employees enrolling in State provided health care plans shall remain the same as those in effect in the Employer’s Agreement with OCSEA. The Employer reserves the right to perform dependent eligibility audits upon recommendation of the Joint Health Care Committee. Health care costs paid on behalf of ineligible dependents will be subject to recovery. Deductibles, co-payments, and other plan design provisions for all benefit programs shall be the same as those prescribed in the Employer’s Agreement with OCSEA. Every year the Employer shall conduct an open enrollment period, at which time employees shall be able to enroll in a health plan, continue enrollment in their current plan, switch to another plan, subject to plan availability in their area, or waive coverage. The timing of the open enrollment period shall be established by the Director of the Department of Administrative Services (DAS), in consultation with the Joint Health Care Committee. Changes outside of open enrollment may only occur as prescribed in the Employer’s Agreement with OCSEA. Open Enrollment Fairs shall be held in accordance with Employer’s Agreement with OCSEA. There shall be established a Joint Health Care Committee composed of representatives of management, and of the various labor Unions representing State employees. The Committee shall meet regularly to monitor the operation of the State’s health care plans, and to make recommendations for the improvement of the plans and cost containment procedures. The Employer shall provide funding for dental, vision and the life benefits as described in Article 21 of the Employer’s Agreement with OCSEA and the Union’s Benefits Trust. Employee health insurance payments will be deducted from every paycheck. In the event an employee is receiving disability leave or Workers’ Compensation benefits, the Employer- policyholder shall continue, at no cost to the employee, the coverage of group health insurance for such employee for the period of such leave, but not beyond twelve (12) months. If the employee’s leave extends beyond twelve

  • OMNIBUS PROCUREMENT ACT OF 1992 It is the policy of New York State to maximize opportunities for the participation of New York State business enterprises, including minority and women-owned business enterprises as bidders, subcontractors and suppliers on its procurement contracts. Information on the availability of New York State subcontractors and suppliers is available from: NYS Department of Economic Development Division for Xxxxx Xxxxxxxx Xxxxxx, Xxx Xxxx 00000 Telephone: 000-000-0000 Fax: 000-000-0000 email: xxx@xxx.xx.xxx A directory of certified minority and women-owned business enterprises is available from: NYS Department of Economic Development Division of Minority and Women's Business Development 000 Xxxxx Xxxxxx Xxx Xxxx, XX 00000 212-803-2414 email: xxxxxxxxxxxxxxxxx@xxx.xx.xxx xxxxx://xx.xxxxxxxxxxxxxx.xxx/FrontEnd/VendorSearchPu blic.asp The Omnibus Procurement Act of 1992 requires that by signing this bid proposal or contract, as applicable, Contractors certify that whenever the total bid amount is greater than $1 million: (a) The Contractor has made reasonable efforts to encourage the participation of New York State Business Enterprises as suppliers and subcontractors, including certified minority and women-owned business enterprises, on this project, and has retained the documentation of these efforts to be provided upon request to the State; (b) The Contractor has complied with the Federal Equal Opportunity Act of 1972 (P.L. 92-261), as amended; (c) The Contractor agrees to make reasonable efforts to provide notification to New York State residents of employment opportunities on this project through listing any such positions with the Job Service Division of the New York State Department of Labor, or providing such notification in such manner as is consistent with existing collective bargaining contracts or agreements. The Contractor agrees to document these efforts and to provide said documentation to the State upon request; and (d) The Contractor acknowledges notice that the State may seek to obtain offset credits from foreign countries as a result of this contract and agrees to cooperate with the State in these efforts.

  • Family Medical Leave Act (FMLA A. The State acknowledges its commitment to comply with the spirit and intent of the leave entitlement provided by the FMLA and the California Family Rights Act (CFRA) referred to collectively as "FMLA." The State and the Union recognize that on occasion it will be necessary for employees of the State to take job- protected leave for reasons consistent with the FMLA. As defined by the FMLA, reasons for an FMLA leave may include an employee's serious health condition, for the care of a child, spouse, or parent who has a serious health condition, and/or for the birth or adoption of a child. B. For the purposes of providing the FMLA benefits the following definitions shall apply: 1. An eligible employee means an employee who meets the eligibility criteria set forth in the FMLA; 2. An employee's child means any child, regardless of age, who is affected by a serious health condition as defined by the FMLA and is incapable of self care. "Care" as provided in this section applies to the individual with the covered health condition;

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