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[Official Guidance]
Text of Agency FAQs on ACA Implementation: (Part XXIX) and Mental Health Parity Implementation
13 Q&As. "Coverage of Preventive Services ... Are plans and issuers required to provide a list of the lactation counseling providers within the network?.... My non-grandfathered group health plan or coverage contains a general exclusion for weight management services for adult obesity. Is this permissible?... If a colonoscopy is scheduled and performed as a screening procedure pursuant to the USPSTF recommendation, is it permissible for a plan or issuer to impose cost sharing for the required specialist consultation prior to the screening procedure?... I am a qualifying non-profit or closely held for-profit employer who sponsors an ERISA-covered self-insured plan, and I have a sincerely held religious objection to providing coverage of contraceptive services. How do I effectuate the religious accommodation, relieving myself of any obligation to contract, arrange, pay, or refer for
that coverage?... "Coverage of BRCA Testing ... Which women must receive coverage without cost sharing for genetic counseling, and if indicated, testing for harmful BRCA mutations?... "Wellness Programs ... My group health plan gives rewards in the form of non-financial (or in-kind) incentives (for example, gift cards, thermoses, and sports gear) to participants who adhere to a wellness program. Are these non-financial incentives subject to the wellness program regulations issued by the Departments? ... "Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and Disclosure ... I am a participant in a group health plan that provides treatment for anorexia as a mental health benefit. In accordance with the plan terms, my provider, on my behalf, requested prior authorization for a 30-day inpatient stay to treat my anorexia. The request was
denied based on the plan's determination that a 30-day inpatient stay is not medically necessary under the plan terms.... Can my plan, upon request, provide a summary description of the medical necessity criteria for both [mental health and substance use disorder (MH/SUD)] benefits and medical/surgical benefits that is written to be understandable for a layperson?"
(Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; U.S. Department of Health and Human Services [HHS]; and U.S. Treasury Department)
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