Proposed Rule to Increase Access to Mental Health Care

Megan Brooks

April 08, 2015

A new rule proposed by the Centers for Medicare and Medicaid Services (CMS) will strengthen mental health and substance use benefits for low-income Americans, including children, the agency says.

The rule, announced April 6, would require provisions of the Mental Health Parity and Addiction Equity Act of 2008 to apply to the majority of Medicaid plans and the Children's Health Insurance Program (CHIP). The act ensures that mental health and substance use disorder benefits are no more restrictive than medical and surgical services.

"Improving quality and access to care impacts the health of our nation. Whether private insurance, Medicaid, or CHIP, all Americans deserve access to quality mental health services and substance use disorder services," Vikki Wachino, acting director, Center for Medicaid and CHIP Services, said in a news release.

The proposed rule ensures that all beneficiaries who receive services through a managed care plan or alternative benefit plan have access to mental health and substance use disorder benefits regardless of whether those services are provided through the managed care plan or other service delivery system, the CMS notes.

Under the proposed rule, states would continue to have flexibility in identifying service delivery systems for Medicaid services provided to beneficiaries while ensuring that enrollees of a Medicaid managed care organization receive the benefit of parity in services provided to them through these various means.

States will be required to include contract provisions requiring compliance with parity requirements in all applicable contracts for these Medicaid managed care arrangements.

The proposed rule requires plans to make available upon request to beneficiaries and contracting providers the criteria for medical necessity determinations with respect to mental health and substance use disorder benefits. The proposed rule also requires the state 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.

Wachino said 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."

Two Thumbs Up

The American Psychiatric Association (APA) welcomes the proposed rule.

"The proposed rule, by expanding mental health parity, has the potential to greatly improve access to care for mental health and substance use disorders and the equity which our patients need," APA President Paul Summergrad, MD, told Medscape Medical News.

"We've made much progress in recent years under the Mental Health Parity Act and the expansion of its applicability under the Affordable Care Act, and this rule will continue that progress by providing greater opportunity for Medicaid beneficiaries to receive the psychiatric and substance use services they need and deserve," he added.

Dr Summergrad noted that the APA is particularly pleased to see the transparency provisions in the rule requiring states to publicly share their compliance with the proposed parity regulations.

"This will help hold states and the payors they use accountable and will allow monitoring of the progress and implementation of parity," he said.

The proposed rule will be published in the Federal Register on April 10 and on FDsys.gov. The deadline to submit comments is June 9.

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