Low-income patients who receive health care coverage from Medicaid and the Children’s Health Insurance Plan would get greater coverage for mental health and substance abuse services under a federal proposed rule issued April 6.
The proposed rule extends to Medicaid and CHIP certain aspects of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, which requires private health insurance to cover mental health and substance abuse treatments as they do medical and surgical services. The 2008 law originally applied to group health plans and group insurance coverage; the Affordable Care Act extended it to individual health insurance policies as well.
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According to the proposed rule, Medicaid managed care organizations will be required to offer the same mental health and substance abuse services, subject to the same financial and treatment limitations consistent with regulations applicable to private insurers in that state. The rule does not applied to fee-for-service Medicaid.
The proposed rule also applies to states that offer Medicaid alternative benefit plans. States delivering services through a non-Medicaid managed care organization “must comply with the same requirements that would be necessary if such services were delivered through a managed care organization,” officials from the Centers for Medicare & Medicaid Services said in a fact sheet about the proposed rule.
All CHIP programs, including fee-for-service and managed care plans, would be subject to the parity standards.
“The proposed rule is a way to advance equity in the delivery of mental health and substance use disorder services. 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.
Approximately 21.6 million Medicaid beneficiaries and 850,000 CHIP beneficiaries would benefit from action, based on estimates from 2012 Medicaid and CHIP enrollment, according to the proposed rule. Among adults aged 18-64 years with Medicaid coverage, about 10% have a serious mental illness, 31% have any mental illness, and 12% have a substance abuse disorder, according to CMS. Additionally, 8% of CHIP beneficiaries “experience serious behavioral or emotional difficulties.”
The proposed rule is slated for publication in the Federal register on April 10; comments will be accepted until June 9 at www.regulations.gov.