Tuesday, April 7, 2015

CMS Proposes Extension of Parity Law to Medicaid Managed Care Plans, CHIP

The Centers for Medicare and Medicaid Services (CMS) is proposing a rule that would apply requirements of the Mental Health Parity and Addiction Equity Act of 2008 to Medicaid managed care plans and the Children’s Health Insurance Program (CHIP).

Under the proposed rule, plans must make available upon request to beneficiaries and contracting providers the criteria for medical-necessity determinations with respect to mental health and substance use disorder benefits. It would also require states to provide enrollees with the reason for any denial of reimbursement or payment for mental health or substance abuse treatment.

The proposed rule does not apply to Medicaid fee-for-services plans, but it does encourage states who have such plans to adopt mental health parity rules. The full scope of the proposed rule applies to CHIP, regardless of whether care is provided through fee-for-service or managed care.

“The proposed rule, by expanding mental health parity, has the potential to greatly improve access to care for mental health and substance use disorders and the equity that our patients need,” said APA President Paul Summergrad, M.D. “We’ve made much progress in recent years under the mental health parity act and the expansion of its applicability under the Affordable Care Act, and this rule will continue that progress by providing greater opportunity for Medicaid beneficiaries to receive the psychiatric and substance use services they need and deserve.”

Summergrad noted that APA is particularly pleased to see the transparency provisions in the rule that would require states to publicly share their compliance with the parity regulations. “This will help hold states and the payors they use accountable and will allow monitoring of the progress and implementation of parity,” he said.

APA leadership is continuing to review the rule in its entirety and will be submitting comments to CMS. The proposed rule is posted at https://www.federalregister.gov/public-inspection and will be published in the Federal Register on April 10. Look for further coverage in Psychiatric News.

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