Mental health parity rules expanded to Medicaid, CHIP

Doctor holding chalkboard with the words Mental Health written on itThe Center for Medicare and Medicaid Services released final regulations March 29 that expand existing mental health care equity laws to Medicaid and the Children’s Health Insurance Program.

The Mental Health Parity and Addiction Equity Act, passed by Congress in 2008, requires health care providers to greatly reduce their traditional practice of underserving mental health and substance abuse services, relative to other medical and surgical benefits.

The Affordable Care Act created a set of “essential health benefits” that applied to all private health care providers, which greatly expanded access to mental health and substance abuse services. In 2013, the CMS released guidance on how the law applies to providers that contract with the CMS through Medicaid and CHIP.

The new regulations [PDF], proposed last April, codify this guidance into law.

“The need to strengthen access to mental health and substance use disorder services is clear,” CMS Deputy Administrator Vikki Wachino said in a news release. “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.”

In addition to its extensive parity requirements, the regulations specify that providers must disclose what mental health and substance abuse services they provide upon request, as well as their criteria for what constitutes medical necessity. They must also accompany denials of services with a written explanation.

CMS retains the authority to deny funding for providers that fail to comply.

Disability rights advocates applauded the ruling.

“NAMI is pleased that the final rule provides needed guidance on how the federal parity law applies to Medicaid and CHIP plans,” said Mary Giliberti, executive director of the National Alliance on Mental Illness, in a news release. “It is a long road to achieve parity. Finalizing the rule is another step forward.”