| Federal Health Law: Update 2008 |
Federal Mental Health Parity Expanded
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (subtitle B of title V of
division C of Public Law 110-343, enacted October 3, 2008), substantially expanded mental health parity requirements for health plans. The law applies to group plans offered by employers with more than 50 employees for plan years after October 3, 2009 (later for union plans).
If a plan includes mental health and/or substance use disorder benefits, the law requires that such benefits be covered on a non-discriminatory basis as compared to medical/surgical benefits, as follows:
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Plans may not contain lower annual and lifetime dollar limits for mental health/substance use disorder benefits
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Plans may not contain more restrictive financial requirements (e.g., deductibles, co-payments) for mental health/substance use disorder benefits
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Plans may not impose more restrictive treatment limitations (e.g., number of visits, inpatient days) for mental health/substance use disorder benefits
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Plans that offer out-of-network medical or surgical care must offer out-of-network care for covered mental health/substance use disorder benefits
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Group Health Insurance Rights of Students on Medical Leave
Michelle’s Law requires group health plans to continue coverage for a child who would otherwise lose eligibility due to a medical leave from a post-secondary educational institution. Michelle’s Law is effective for plan years that begin on or after October 9, 2009.
Plans may not terminate coverage for one year after a "medically necessary" leave of absence begins unless coverage ends under the plan for all dependents. A qualifying leave of absence must:
(1) begin while the child is suffering from a serious illness or injury;
(2) be certified by a physician as medically necessary; and
(3) cause the child to lose student status for purposes of coverage under the plan.
| Genetic Information Nondiscrimination Act
The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits discrimination on the basis of genetic information in health insurance and employment. "Genetic information" is information about an individual's or his or her family member's genetic tests, as well as information about the manifestation of a disease or disorder in a family member. "Family member" is defined expansively. Information about an individual's gender is not "genetic information" within the meaning of the law.
GINA amends ERISA, the Public Health Service Act, the Internal Revenue Code and the HIPAA Privacy Rule, and applies to both group health plans and insurance in the individual market. Draft regulations were released for comment March 2; final regulations are expected in late May.
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ADA Amendments Act Clarifies "Disability"
The ADA Amendments Act of 2008 clarifies the definition of disability effective January 1, 2009. The changes reinstate a broad scope of protection under the ADA, rejecting Supreme Court decisions that narrowed the law’s application.
The legislation makes clear that the definition of disability is to be construed in favor of broad coverage. Courts must generally determine whether a physical or mental impairment substantially limits a major life activity without considering the impact of mitigating measures, such as medications.
| Expanded FMLA Leave for Military Families
Pursuant to the National Defense Authorization Act for Fiscal Year 2008, the Family and Medical Leave Act (FMLA) was amended effective January 28, 2008 to allow two new types of leave for employees who are relatives of "servicemembers." First, an eligible employee may take up to 12 work weeks of leave during any 12-month period for a "qualifying exigency" arising because the employee's spouse, child, or parent is on active duty (or has called to active duty) in support of a specified military operation. Second, an eligible employee who is the spouse, child, parent, or next of kin of a "covered servicemember" may take up to 26 work weeks of leave during a 12-month period to care for the servicemember.
Final regulations took effect January 16. See also http://www.dol.gov/esa/whd/fmla/NDAA_fmla.htm.
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Final Regulations on Maternity Stays
The federal government has issued final regulations regarding hospital length-of-stay requirements for newborns and mothers. These regulations apply to group health plans and health insurance issuers in the group and individual markets for plan years beginning on or after January 1, 2009. The rules generally prohibit plans from restricting mothers' and newborns' benefits for a hospital length of stay in connection with childbirth to less than 48 hours (96 hours after caesarean). The regulations also clarify criteria for determining whether insurance coverage is subject to the federal requirements or state insurance laws.
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