Latest FAQs on PPACA Shed Light on Compliance Timeline

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Until the final regulation is issued regarding the implementation of market reform provisions under the Patient Protection and Affordable Care Act, employee benefits plans are not required to comply with the provisions of the proposed rule, federal officials said Nov. 18.

The final rule under a PPACA provision requiring health care insurers and group health plans to make available to consumers a standardized summary of the benefits and coverage for each plan will be released “as soon as possible,” according to a set of frequently asked questions recently posted to the Department of Labor's website.

DOL's Employee Benefits Security Administration posted the seventh set of FAQs regarding the implementation of provisions under the PPACA as well as questions and answers regarding mental health parity requirements. The guidance was prepared jointly with the departments of Treasury and Health and Human Services.

The response about the release of the final rule was prompted by many comments asking what steps plans should be taking now to prepare for the final rule's requirements ahead of the proposed applicability date of March 23, 2012.

The departments also said an applicability date will be included in the final rule giving health plans and insurers ample time to comply.

PPACA requires all group and individual health plans, including “grandfathered” plans—those in existence when the law was enacted in 2010—to provide consumers with a uniform disclosure form containing standard definitions of benefits and information on coverage. In comment letters filed on the proposed rule, insurers and employer groups said it was inappropriate for large self-insured plans and would add significant costs without providing enough value to consumers (62 BTM 356, 11/8/11).

The departments also posted several FAQs addressing the implementation of the Mental Health Parity and Addiction Equity Act of 2008 (Pub. L. No. 110-343).

In February 2010, DOL, HHS, and Treasury published interim final rules implementing the 2008 mental health parity law, which requires group health plans to treat medical and mental health benefits equally (61 BTM 39, 2/2/10).

The FAQs in part said a group health plan is not permitted to require prior authorization from its utilization reviewer for use of mental health and substance use disorder benefits if it does not require prior authorization for use of medical or surgery benefits.

The FAQs are available on the Department of Labor's website at .