CMS Issues Proposed Mental Health Parity Rule for Medicaid, CHIP

CMS has issued a proposed rule that would "align mental health and substance use disorder benefits for low-income Americans with benefits required of private health plans and insurance," according to a press release from the agency.

The proposed rule would apply certain provisions of the Mental Health Parity and Addiction Equity Act of 2008 to both Medicaid and the Children's Health Insurance Program (CHIP).

Under the proposed rule:

• All beneficiaries who receive services through managed care organizations (MCOs) or alternative benefit plans would receive access to mental health and substance use disorder benefits, regardless of whether services are provided through MCOs or another service delivery system
• Plans must make the criteria for medical necessity determinations for mental health and substance abuse disorders available to beneficiaries and contracting providers 
• States would be required to make available to enrollees the reasons for any denial of reimbursement or payment for services related to mental health and substance use 
• States would still have flexibility in providing services through managed care delivery mechanisms other than Medicaid MCOs and must ensure that Medicaid MCO enrollees receive parity in services from these groups

To read the press release, click here.