HomeMy WebLinkAboutResolution - 2010-R0004 - City Manager Notices Required By HIPAA, CMS, MHPAEA For Chemical Dependency - 01/14/2010Resolution No. 2010-R0004
January 14, 2010
Item No. 5.4
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the City Manager, or her designee, is directed to prepare and deliver the
notice(s) required by the Health Insurance Portability and Accountability Act (HIPAA) to
notify the Center for Medicare and Medicaid Services (CMS), City employees, retirees
and dependents, and the third party administrator that the City of Lubbock has opted out
and is electing exemption from the requirements of the Mental Health Parity and
Addiction Equity Act (MHPAEA) requiring that inpatient and outpatient mental health
care and the treatment of chemical dependency be covered as any other illness.
Passed by the City Council this 14th
day of January , 2010.
TOM MARTIN, MAYOR
ATTEST:
Rebecca Garza, City Secretary
APPROVED AS TO CONTENT:
Leisa Hutchenson. Director of Human Resources
APPROVED AS TO FORM:
y� c
Chad Weaver, Assistant City Attorney
sj:ccdocs Res.BCBS Employee Benefit Plan Amendment 6
December 31. 2009
BlueCross BlueShielcl
ai'IiexaB Resol.ntbor� No. 2010--820004
Signature required only in the event of denial or "opt out" of Amendment No. 5
MENTAL HEALTH PARITY and ADDICTION EQUITY ACT ELECTIONS
New Federal Requirements for Mental Health Care, Serious Mental Illness, and Treatment of Chemical
Dependency Coverage
On October 3, 2008, President Bush signed the Emergency Economic Stabilization Act of 2008. This legislation included the Mental
Health Parity and Addiction Equity Act (MHPAEA) which amends the Employee Retirement Income Security Act (ERISA), the Internal
Revenue Code (Code) and the Public Health Service Act (PHSA). The MHPAEA generally requires that group health plans and group
health insurers apply the same treatment and financial limits to medical and surgical benefits and to mental health and substance use
disorder benefits.
The MHPAEA does not mandate coverage of mental health, serious mental illness, or chemical dependency (substance abuse). It does,
however, require group health plans that cover mental health care, serious mental illness, and/or treatment of chemical dependency
not apply more restrictive treatment limitations (number of visits, days of coverage or other similar limits on the scope or duration of
treatment) or Ananciairequirements (deductibles, copayments, coinsurance, and out-of-pocket expenses) than those applied to
substantially all medical and surgical benefits. As applies to PPO plans, parity requirements also apply to the out -of -network coverage
for medical and surgical benefits and mental health and chemical dependency benefits. For renewing groups, the provisions of the law
will go into effect on your renewal date beginning on and after October 3, 2009. It is important that you review your plan design in
light of this new law and provide notice of your elections to Blue Cross and Blue Shield of Texas (BCBSTX) as your claims administrator.
Benefits for Serious Mental Illness (check the box that aDDlies — must select one)
X
We are a public entity, therefore, benefits for serious mental illness are paid same as any other physical illness. No changes are
necessary.
❑
We are not a public entity and have elected to provide benefits for serious mental illness same as any other physical illness with no
inpatient day or outpatient visit limitations. All benefits paid are to be applied to the maximum lifetime benefits amount of the plan.
❑
We are not a public entity and have elected to no longer provide benefits for serious mental illness.
❑
Benefits for serious mental illness are carved out of the group health plan administered by BCBSTX and are administered by another
vendor. Itis our desire that medical and serious mental illness claims paid be accumulated to apply to any deductibles, co -share
amounts, and maximum lifetime benefits of the plan.*
❑
Benefits for serious mental illness are carved out of the group health plan administered by BCBSTX and are administered by another
vendor. It is not our desire that medical and serious mental illness claims paid be accumulated to apply to any deductibles, co -share
amounts, and maximum lifetime benefits of the plan. NOTE: this option is not available for PPO plans that accompany an HSA.
Benefits for Treatment of Chemical Dependency (check the box that applies - must select one)
❑
We have elected to provide benefits for treatment of chemical dependency same as any other illness with no limitations on series of
treatments. All benefits paid are to be applied to the maximum lifetime benefits of the plan.
❑
We have elected to no longer provide benefits for treatment of chemical dependency. We understand, however, that benefits for
medical management of acute life-threatening intoxication (toxicity) in a Hospital will be available on the same basis as for sickness
generally as described under Benefits for Inpatient Hospital Expenses.
❑
Benefits for treatment of chemical dependency are carved out of the group health plan administered by BCBSTX and are administered
by another vendor. It is our desire that medical and treatment of chemical dependency claims paid be accumulated to apply to any
deductibles, co -share amounts, and maximum lifetime benefits of the plan.*
❑
Benefits for treatment of chemical dependency are carved out of the group health plan administered by BCBSTX and are administered
by another vendor. It is not our desire that medical and treatment of chemical dependency claims paid be accumulated to apply to any
deductibles, co -share amounts, and maximum lifetime benefits of the plan. NOTE: this option is not available for PPO plans that
accompany an HSA.
X
We are a self-funded, nonfederal governmental entity that provides group health plan coverage to our employees. We will be
submitting our election for exemption to the parity in application of certain limits to mental health and substance abuse benefits to the
Centers for Medicare and Medicaid Services (CMS). Required documentation for BCBSTX will be included in accordance with
instructions in the Legislative Elections section of the ASO Benefits Program Application.
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
Non -HMO Renewal-MHPAEA(Rev.9.16.09) Page 1 of 3
h k th bo th t lies - must select one
BeneTits Tor
❑
dental Health CV.;-are c e x a UEE
We have elected to provide benefits for mental health care same as any other illness with no limitations inpatient days or outpatient
visits. All benefits paid are to be applied to the maximum lifetime benefits amount of the plan.
❑
We have elected to no longer provide benefits for mental health care.
❑
Benefits for mental health care are carved out of the group health plan administered by BCBSTX and are administered by another
vendor. It is our desire that medical and mental health claims paid be accumulated to apply to any deductibles, co -share amounts, and
maximum lifetime benefits of the plan.*
❑
Benefits for mental health care are carved out of the group health plan administered by BCBSTX and are administered by another
vendor. It/snotourdesirethat medical and mental health claims paid be accumulated to apply to any deductibles, co -share amounts,
and maximum lifetime benefits of the plan. NOTE: this option is not available for PPO plans that accompany an HSA.
X
We are a self-funded, nonfederal governmental entity that provides group health plan coverage to our employees. We will be
submitting our election for exemption to the parity in application of certain limits to mental health and substance abuse benefits to the
Centers for Medicare and Medicaid Services (CMS). Required documentation for BCBSTX will be included in accordance with
instructions in the Legislative Elections section of the ASO Benefits Program Application.
.J--.. wLL.wr
*If benefits for Mental Health Care, Serious Mental Illness, and / or treatment or Lnemicai uepenuency drew ue caivcu Out. w 0"wu1C
vendor and the Plan Sponsor desires accumulated amounts to be applied to any deductibles and calendar year maximums of the plan,
please provide the following:
Vendor name:
Address:
City
Phone number:
Contact, if available:
State
Special effective date rule for group health plans maintained pursuant to one or more collective bargaining agreements (CBA):
MHPAEA provisions will not apply to plan years beginning before the later of (A) the date on which the last of the collective bargaining agreements
relating to the plan terminates, or (B) January 1, 2010.
The CBA for Group #/Benefit Agreement #
will expire on [month/dav/vearl , at which time we will notify BCBSTX of our
BCBSTX, as your claims administrator, is ready to assist you with any questions you may have regarding the elections above. Contact
your Marketing Account Representative.
The information and elections provided in this addendum should not be construed as legal advice for implementation of the Mental
Health Parity and Addiction Equity Act of 2008. The Department of Labor is responsible for enforcing the provisions of the Mental
Health Parity and Addiction Equity Act with respect to ERISA group health plans. Penalties may be assessed for non-compliance. The
Plan Sponsor retains the final authority and responsibility to establish the terms and conditions of the group health plan and is
encouraged to seek legal counsel with any questions concerning compliance with this federal law.
Non -HMO Renewal-MHPAEA(Rev.9.16.09) Page 2 of 3
Dated this 14th day of January, 2010.
Tom Martin, Mayor
ATTEST:
Rebecca a, City Secretary
APPROU D O CONTENT:
-'
Leisa Hutcheson, Director Human Resources
APPRO � O FO M:
Chad Weaver, Assistant City Attorney
Non -HMO Renewal-MHPAEA(Rev.9.16.09) Page 3 of 3