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Mental Health Coverage Parity for Medicaid, CHIP Now Final

A final regulation published today applies provisions of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to Medicaid alternative benefit plans, the Children’s Health Insurance Program (CHIP), and Medicaid managed care organizations.

The MHPAEA requires insurance plans to provide comprehensive mental health and substance use disorder benefits that are equal to medical and surgical benefits. The final rule aims to ensure patients in Medicaid alternative benefit plans, CHIP, and Medicaid managed care have access to these benefits.

Under today’s final rule from the Centers for Medicare & Medicaid Services (CMS), plans must disclose information on mental health and substance use disorder benefits upon request, including criteria for determining medical necessity. The final rule also requires states to disclose the reason for denial of reimbursement or payment for services with respect to mental health and substance use disorder benefits.

America’s Essential Hospitals submitted comments supporting CMS’ efforts, but urged the agency to

  • expand its proposal to all Medicaid and CHIP delivery systems;
  • provide robust guidance and oversight to states; and
  • confirm that states will account for increased costs for these services in payments to managed care organizations.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Gontscharow is a senior policy analyst for America's Essential Hospitals.