Common use of Mental Health Parity Compliance Clause in Contracts

Mental Health Parity Compliance. The PIHP must comply with the Mental Health Parity Rule requirements of 42 CFR § 438.930. The Mental Health Parity Rule, in 42 CFR § 438.910(b)(2), requires the PIHP to provide mental health or substance abuse benefits to members in every classification in which medical benefits are provided (e.g., inpatient, outpatient, emergency care, prescription drugs). The PIHP must not establish any of the following when it has been determined that mental health or substance abuse treatment is medically necessary for the member:  Any aggregate lifetime or annual dollar limits on mental health or substance abuse benefits;  Any financial requirement or treatment limitation to mental health or substance abuse benefits;  Any limit on the number of hours of outpatient treatment that the PIHP must provide or reimburse, and  Any monetary limit or limit on the number of days of inpatient hospital treatment. The PIHP prior authorization requirements must comply with the requirements for parity in mental health and substance abuse benefits in 42 CFR §438.910 (d). The same section of the Mental Health Parity Rule also specifies that the PIHP may not impose non-quantitative treatment limits (NQTL) for mental health or substance abuse benefits in any classification unless, the PIHP has processes, strategies evidentiary standards, or other factors used in applying the NQTL to mental health or substance abuse benefits that are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical benefits. Pursuant to 42 CFR Part 438, subpart K, the PIHP will be required to submit to the Department its Mental Health Parity Rule compliance plan as part of the PIHP certification application process and upon request. Additional information on covered services is available in Addendum VI, as well as in Provider Updates and through interChange.

Mental Health Parity Compliance. The PIHP must comply with the Mental Health Parity Rule requirements of 42 CFR § 438.930. The Mental Health Parity Rule, in 42 CFR § 438.910(b)(2), requires the PIHP to provide mental health or substance abuse benefits to members in every classification in which medical benefits are provided (e.g., inpatient, outpatient, emergency care, prescription drugs). The PIHP must not establish any of the following when it has been determined that mental health or substance abuse treatment is medically necessary for the member:  • Any aggregate lifetime or annual dollar limits on mental health or substance abuse benefits;  • Any financial requirement or treatment limitation to mental health or substance abuse benefits;  • Any limit on the number of hours of outpatient treatment that the PIHP must provide or reimburse, ; and  • Any monetary limit or limit on the number of days of inpatient hospital treatment. The PIHP prior authorization requirements must comply with the requirements for parity in mental health and substance abuse benefits in 42 CFR §438.910 (d). The same section of the Mental Health Parity Rule also specifies that the PIHP may not impose non-quantitative treatment limits (NQTL) for mental health or substance abuse benefits in any classification unless, the PIHP has processes, strategies evidentiary standards, or other factors used in applying the NQTL to mental health or substance abuse benefits that are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical benefits. Pursuant to 42 CFR Part 438, subpart K, the PIHP will be required to submit to the Department its Mental Health Parity Rule compliance plan as part of the PIHP certification application process and upon request. Additional information on covered services is available in Addendum VI, as well as in Provider Updates and through interChange.

Mental Health Parity Compliance. The PIHP must comply with the Mental Health Parity Rule requirements of 42 CFR § 438.930. The Mental Health Parity Rule, in 42 CFR § 438.910(b)(2), requires the PIHP to provide mental health or substance abuse benefits to members in every classification in which medical benefits are provided (e.g., inpatient, outpatient, emergency care, prescription drugs). The PIHP must not establish any of the following when it has been determined that mental health or substance abuse treatment is medically necessary for the member:  • Any aggregate lifetime or annual dollar limits on mental health or substance abuse benefits;  • Any financial requirement or treatment limitation to mental health or substance abuse benefits;  • Any limit on the number of hours of outpatient treatment that the PIHP must provide or reimburse, and  • Any monetary limit or limit on the number of days of inpatient hospital treatment. The PIHP prior authorization requirements must comply with the requirements for parity in mental health and substance abuse benefits in 42 CFR §438.910 (d). The same section of the Mental Health Parity Rule also specifies that the PIHP may not impose non-quantitative treatment limits (NQTL) for mental health or substance abuse benefits in any classification unless, the PIHP has processes, strategies evidentiary standards, or other factors used in applying the NQTL to mental health or substance abuse benefits that are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical benefits. Pursuant to 42 CFR Part 438, subpart K, the PIHP will be required to submit to the Department its Mental Health Parity Rule compliance plan as part of the PIHP certification application process and upon request. Additional information on covered services is available in Addendum VI, as well as in Provider Updates and through interChange.

Mental Health Parity Compliance. The PIHP must comply with the Mental Health Parity Rule requirements of 42 CFR § 438.930. The Mental Health Parity Rule, in 42 CFR § 438.910(b)(2), requires the PIHP to provide mental health or substance abuse benefits to members in every classification in which medical benefits are provided (e.g., inpatient, outpatient, emergency care, prescription drugs). The PIHP must not establish any of the following when it has been determined that mental health or substance abuse treatment is medically necessary for the member:  Any aggregate lifetime or annual dollar limits on mental health or substance abuse benefits;  Any financial requirement or treatment limitation to mental health or substance abuse benefits;  Any limit on the number of hours of outpatient treatment that the PIHP must provide or reimburse, and  Any monetary limit or limit on the number of days of inpatient hospital treatment. The PIHP prior authorization requirements must comply with the requirements for parity in mental health and substance abuse benefits in 42 CFR §438.910 (d). The same section of the Mental Health Parity Rule also specifies that the PIHP may not impose non-quantitative treatment limits (NQTL) for mental health or substance abuse benefits in any classification unless, the PIHP has processes, strategies evidentiary standards, or other factors used in applying the NQTL to mental health or substance abuse benefits that are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical benefits. Pursuant to 42 CFR Part 438, subpart K, the PIHP will be required to submit to the Department its Mental Health Parity Rule compliance plan as part of the PIHP certification application process and upon request. Additional information on covered services is available in Addendum VI, as well as in Provider Updates and through interChange.