CHA News Article

CMS Issues Proposed Rule Implementing Mental Health Parity for Medicaid Managed Care, CHIP
Comments are due June 9

The Centers for Medicare & Medicaid Services (CMS) has issued the attached proposed rule applying certain provisions of the Mental Health Parity and Addiction Equity Act of 2008 to Medicaid managed care organizations (MCOs), the Children’s Health Insurance Program (CHIP) and alternative benefit plans (ABPs). The proposed rule requires that all beneficiaries who receive services through MCOs or under ABPs have access to mental health and substance use disorder benefits regardless of whether services are provided through the MCO 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.

The proposed rule would mandate that states require compliance with the parity law in contracts for Medicaid managed care. Additionally, plans would have to make available upon request to beneficiaries and contracting providers the criteria for medical necessity determinations of mental health and substance use disorder benefits. The proposed rule also would require states to make available to the enrollee the reason for any denial of reimbursement or payment for services with respect to mental health and substance use disorder benefits.

CHA is currently reviewing the proposed rule and will provide members with a more detailed summary in the coming weeks. Comments on the proposed rule are due June 9.