April 23, 2015

Mental Health Parity

On April 6 the Centers for Medicare and Medicaid Services (CMS) released a long-awaited proposed rule applying certain provisions of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 to Medicaid and the Children's Health Insurance Program (CHIP). The Act is intended to ensure that mental health and substance use disorder benefits are no more restrictive than medical and surgical services.


According to the CMS press release, “The proposed rule ensures that all beneficiaries who receive services through managed care organizations or under alternative benefit plans have access to mental health and substance use disorder benefits regardless of whether services are provided through the managed care organization or another service delivery system. The full scope of the proposed rule applies to CHIP, regardless of whether care is provided through fee-for-service or managed care.”


Under the proposed rule, states would be required to include provisions requiring compliance with the parity standards in all applicable Medicaid managed care contracts.  Upon request, plans would have to provide beneficiaries and contracting providers with their criteria for medical necessity determinations with respect to mental health and substance use disorder benefits.  In addition, states would have to supply an enrollee with the reason for any denial of reimbursement or payment for services with respect to mental health and substance use disorder benefits.


The proposed rule is similar to a rule released in November 2013 that applies the mental health parity act to private insurance plans.


Public comments on the proposed rule are due on June 9.  For a fact sheet and other information related to the application of the MHPAEA to Medicaid and CHIP, see this page from Medicaid.gov.  See also this article from Kaiser Health News.