EBSA Provides Additional Guidance Regarding the Patient Protection and Affordable Care Act, the Mental Health Parity and Addiction Equity Act and the Health Insurance Portability and Accountability Act

The U.S. Department of Labor’s Employee Benefits Security Administration (“EBSA”) recently provided additional guidance on its website regarding implementation of provisions of the Patient Protection and Affordable Care Act (PPACA), implementation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This guidance, which is provided in the form of Frequently Asked Questions and responses, was prepared jointly by the Departments of Health and Human Services, Labor and the Treasury.

Some of the highlights from the guidance include the following:

• For preventive services, group health plans can steer individuals towards a particular high-value setting such as ambulatory care so long as the plan provides for a waiver of the co-payment for those individuals for whom it would be medically inappropriate to go to an ambulatory setting.
• Until regulations are issued by the Secretary of Labor, employers do not have to comply with the new automatic enrollment requirements in section 18A of the Fair Labor Standards Act. The Department of Labor intends to complete this rulemaking by 2014.
• While the PPACA generally prohibits distinctions based upon age in dependent coverage of children, distinctions based upon age that apply to all coverage under the plan, including coverage for employees and spouses as well as dependent children, are not prohibited.
• Under certain circumstances, issuers may screen applicants for eligibility for alternative coverage options before offering a child-only policy, provided this practice does not violate any state law.
• Small employers continue to be exempt from the MHPAEA requirements.
• Only employment-based wellness programs that are, or are part of, a group health plan are subject to the HIPAA nondiscrimination rules. Wellness programs that are not part of the group health plan may be covered by other federal or state nondiscrimination laws, but are not subject to the HIPAA nondiscrimination regulations.