Mental Health symptoms of tolerance or physiological and/or psychological and Substance withdrawal if use of the controlled substance or alcoholic beverage Use Disorder is reduced or discontinued; and the user's health is substantially (MH/SUD) impaired or endangered or his or her social or economic function is Services, substantially disrupted. Any disorder defined by the plan as being Including or as not being a substance use disorder must be defined to be consistent with generally recognized independent standards of current medical practice (for example, the most current version of the DSM, the most current version of the ICD, or state guidelines).” Mental Plan may not any financial requirement or treatment limitation to P.L. 110-343 Health MH/SUD benefits that is more restrictive than those applied to Parity medical/surgical benefits. (Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”)) The copayment or coinsurance for mental health services may be no RCW 48.46.291 more than the copayment or coinsurance for medical and surgical (2)(c)(i) services otherwise provided the health benefit plan. Preventive services are excluded from this comparison. RCW 48.46.291 If the plan has a maximum out-of-pocket or stop loss, it must be Mental (2)(c)(i) for medical, surgical, and mental health - it cannot have a separate Health MOOP or stop loss for mental health. Parity RCW 48.46.291 If the plan has any deductible, it must be for medical, surgical, and (Cont’d) (2)(c)(i) – mental health it cannot have a separate deductible for mental health. RCW Prescription drugs intended to treat any MH/SUD disorder must be 48.46.291 covered to the same extent, and under the same terms and (2)(c)(ii) conditions, as other covered prescription drugs. RCW 48.46.292 No preauthorization is required for mental health treatment rendered by a state hospital if the enrollee or covered dependent is involuntarily
Mental Health and Substance Use Disorder (MH/SUD) Services, Including symptoms of tolerance or physiological and/or psychological withdrawal if use of the controlled substance or alcoholic beverage is reduced or discontinued; and the user's health is substantially impaired or endangered or his or her social or economic function is substantially disrupted. Any disorder defined by the plan as being or as not being a substance use disorder must be defined to be consistent with generally recognized independent standards of current medical practice (for example, the most current version of the DSM, the most current version of the ICD, or state guidelines).” Mental Health Parity Mental Health Parity (Cont’d) P.L. 110-343 Plan may not any financial requirement or treatment limitation to MH/SUD benefits that is more restrictive than those applied to medical/surgical benefits. (Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”)) RCW 48.46.291 (2)(c)(i) The copayment or coinsurance for mental health services may be no more than the copayment or coinsurance for medical and surgical services otherwise provided the health benefit plan. Preventive services are excluded from this comparison. RCW 48.46.291 (2)(c)(i) If the plan has a maximum out-of-pocket or stop loss, it must be for medical, surgical, and mental health - it cannot have a separate MOOP or stop loss for mental health. RCW 48.46.291 (2)(c)(i) If the plan has any deductible, it must be for medical, surgical, and mental health – it cannot have a separate deductible for mental health. RCW 48.46.291 (2)(c)(ii) Prescription drugs intended to treat any MH/SUD disorder must be covered to the same extent, and under the same terms and conditions, as other covered prescription drugs. RCW 48.46.292 No preauthorization is required for mental health treatment rendered by a state hospital if the enrollee or covered dependent is involuntarily
cl-forms-19-hmo-ind-analyst-checklist.docx