Draft regulations issued Monday would extend federal mental health parity protections to Medicaid beneficiaries enrolled in managed-care plans.
The proposed rule applies provisions of the Mental Health Parity and Addiction Equity Act of 2008 (PDF) to managed-care plans contracting with Medicaid and the Children's Health Insurance Program. It would ensure beneficiaries have access to mental health and substance abuse benefits regardless of whether services are provided through the managed-care organization or another service delivery system.
The parity provisions would not, however, apply to beneficiaries in traditional Medicaid programs. Officials note in the regulation that they hope the policy will encourage states to modify their Medicaid benefits consistent with it.
The prevalence of managed care, however, is growing quickly in the state programs. Currently, 37 states and the District of Columbia contract with managed-care plans to administer benefits to at least some of their beneficiaries.
About 21.6 million Medicaid beneficiaries and 850,000 CHIP beneficiaries are expected to take advantage of the new access to care. The services are expected to cost the federal government and states about $1 billion between fiscal 2015 and fiscal 2019.
“The proposal will support federal and state efforts to promote access to mental health and substance use services as part of broader delivery system reform through the Affordable Care Act,” Vikki Wachino, acting director of the Center for Medicaid and CHIP Services, said in a statement.
Beneficiaries in these plans now have some access to mental and substance abuse services, but the plans often limit the number of days or visits. The rule would end such restrictions.
Medicaid plans would also be required to outline the criteria they use to determine medical necessity for mental health and substance abuse benefits. States would have to explain payment and reimbursement denials to enrollees.
The deadline to submit comments on the proposed rule is June 9.