Form to Request Documentation from an Employer-Sponsored Plan or an Issuer Concerning Treatment Limitations
Guidance for Draft model form that consumers may use to request information from their health plan regarding treatment limitations that may affect access to mental health or substance use disorder benefits.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: April 23, 2018
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.