CMS proposes rule to Medicaid, CHIP to improve access to mental health, substance use disorder services

CMS has proposed a rule that aims to improve Americans’ access to mental health and substance use disorder health care benefits and services.

The rule applies to certain provisions of the Mental Health Parity and Addiction Equity Act of 2008 to Medicaid and Children’s Health Insurance Program (CHIP), which ensures mental health and substance use disorder benefits are as comprehensive as 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,” Victoria Wachino, MPP, acting director of the Center for Medicaid and CHIP Services, said in a press release.

Victoria Wachino

The proposed rule will guarantee that all patients who receive services through managed care organizations or alternative benefit plans have access to mental health and substance use disorder benefits regardless of whether those services are provided through the managed care organization or alternative benefit plan, according to the release.

Under the proposed rule, health care plans will be required to identify what criteria need to be met to be eligible for mental health and substance abuse disorder benefits, upon the beneficiary’s request. Further, the proposed rule will require U.S. states to inform enrollees of the reason for any denial of reimbursement or payment for services regarding mental health and substance use disorder benefits.

States will continue to have the flexibility of identifying various delivery systems for Medicaid services to beneficiaries while guaranteeing they have comparable access to all benefits provided through these various systems.

“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,” Wachino said.

For more information, visit http://www.medicaid.gov/medicaid-chip-program-information.

To view the proposed rule, visit https://s3.amazonaws.com/public-inspection.federalregister.gov.