CMS finalized a mental health and substance use services ruling
The Centers of Medicare & Medicaid Services (CMS) finalized a mental health and substance use services disorder parity rule for Medicaid and Children?s Health Insurance Program (CHIP) coverage. The final rule was announced during the President Obama?s visit to the National Rx Drug Abuse and Heroin Summit. In a press release Deputy Administrator of CMS and Director of the Center for Medicaid and CHIP Services said, ?This final rule will help states strengthen care delivery and support low-income individuals in accessing the services and treatment they need to be healthy.? This rule is said to benefit over 23 million people who are enrolled in Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and CHIP.
The final rule will give states the flexibility to provide services through a managed care delivery system and also will guarantee Medicaid enrollees have access to important mental health and substance use services, the same as they would other medical benefits.
The U.S. Department of Health & Human Services Secretary said the rule eliminates a barrier to coverage for the millions of Americans who for too long faced a system that treated behavioral health as an unequal priority. It represents a critical step in our effort to ensure that everyone has access to the care they need.
This rule will also increase access to evidence-based treatment to help more people get the help they need for their recovery and is critical in our comprehensive approach to addressing the serious opioid epidemic facing our nation. ?The need to strengthen access to mental health and substance use disorder services is clear”. ?This final rule will help states strengthen care delivery and support low-income individuals in accessing the services and treatment they need to be healthy.?
Under the final rule, plans must disclose information on mental health and substance use disorder benefits upon request, including the criteria for determinations of medical necessity. The final rule also requires the state to disclose the reason for any denial of reimbursement or payment for services with respect to mental health and substance use disorder benefits.
This rule promises to increase access to and improve mental health services and care for low income individuals, especially in light of the opioid abuse epidemic, which constitute significant health risks and cost drivers in the Medicaid program.