CMS Looks To Expand Parity for Mental Health, Substance Misuse

On Monday, CMS issued a proposed rule that would extend mental health and substance use disorder treatment parity requirements to the Children's Health Insurance Program, Medicaid alternative benefit plans and Medicaid managed care plans, the Wall Street Journal reports (Armour, Wall Street Journal, 4/6).

Background

Under final rules released in 2013 for the 2008 Mental Health Parity and Addiction Equity Act, insurers and group health plans are required to cover treatment for mental health issues and substance use disorders in the same way they do physical illnesses. For example, insurers are prohibited from setting different rules for copayments and doctors' visits for patients with such issues (California Healthline, 11/8/13).

Details of Proposed Rule

According to Modern Healthcare, the new proposed rule would affect about 850,000 CHIP beneficiaries and about 21.6 million Medicaid beneficiaries. Thirty-seven states and Washington, D.C., currently contract with managed care plans to provide benefits to at least a portion of their CHIP or Medicaid beneficiaries (Dickson, Modern Healthcare, 4/6). About 70% of Medicare beneficiaries are in managed care plans.

The proposed rule would not apply to fee-for-service Medicaid plans.

The proposed rule also would require CHIP, Medicaid alternative benefit plans and Medicaid managed care plans to inform beneficiaries of the reason for any denial of payment for substance use disorder or mental health treatment.  

In addition, states would need to have parity provisions in their Medicaid managed care contracts. States would not be allowed to exclude treatment for substance use disorders or mental health issues from such contracts (Wall Street Journal, 5/6).

The proposed rule is expected to cost states and the federal government about $1 billion between fiscal year 2015 and FY 2019 (Modern Healthcare, 4/6). Specifically, the proposal could cost state governments about $150 million in the short term, according to National Association of Medicaid Directors Executive Director Matt Salo.

CMS is accepting public comments on the proposed rule through June 9 (Wall Street Journal, 5/6).

Reaction

Center for Medicaid and CHIP Services Acting Director Vikki Wachino said, "Whether private insurance, Medicaid or CHIP, all Americans deserve access to quality mental health services and substance use disorder services" (Gold, Kaiser Health News, 4/7).

In a release, Salo said that the "release of draft regulations regarding mental health parity and addiction equity is an important step in an ongoing conversation about how best to integrate behavioral health treatment into the rest of the health care system" (Wall Street Journal, 4/6).

Meanwhile, former Rhode Island Rep. Patrick Kennedy (D) -- lead author of the 2008 law -- criticized the delay in releasing the proposed rule. He said, "Even if this rule goes forward, it's going to be at least another 18 months to implement it. We're going to be a decade … between when the law was passed and when it's going to be effective. It's very emblematic of what we’ve always faced in mental health. We're always secondary and an afterthought in health care."

In addition, some stakeholders expressed concern that a shortage of mental health providers who accept Medicaid beneficiaries could limit access to care. Emily Feinstein --  director of health law and policy at CASAColumbia, a substance use disorder treatment advocacy center -- said that the proposed rule would "not be enough to overcome all of the barriers that patients face in accessing care, including an insufficient number of in-network providers" (Kaiser Health News, 4/7).