- Today, CMS revealed a final rule aimed at making sure mental health and substance use services are covered to the same extent as treatments for physical conditions for Medicaid and CHIP enrollees. More than 23 million people are currently enrolled in MCOs, ABPs, and CHIP.
- The rule was designed to be closely aligned to the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) as CMS hopes to promote consistency in the commercial and Medicaid markets.
- On Tuesday, HHS released a report that suggests Medicaid expansion under the ACA led to better access to mental health services. About 1.9 million low-income uninsured people with a mental illness or substance use disorder lived in states that had not expanded Medicaid in 2014.
MHPAEA, consisting of amendments to the Public Health Service Act, ERISA, and the Internal Revenue Code, requires insurers provide mental health and substance use disorder benefits, including co-pays, deductibles, and visit limits that are "no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits," according to a fact sheet from the U.S. Department of Labor.
HHS Secretary Sylvia M. Burwell noted in a prepared statement the ACA "provided one of the largest expansions of mental health and substance use disorder coverage in a generation.”
“Today’s 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," Burwell said. "It represents a critical step in our effort to ensure that everyone has access to the care they need."
According to Burwell, the move is key in the agency's approach to combating the country's prescription opioid misuse and heroin epidemic.
HHS announced plans earlier this month to provide 271 health centers nationwide with $94 million in ACA funds to address opioid and heroin misuse. Also earlier this month, the Senate's committee on Health, Education, Labor and Pensions approved the Mental Health Reform Act (HELP).
The White House released a fact sheet announcing additional actions, both in the public and private sector, to addressing the opioid and heroin epidemic, which include:
- Creating a Mental Health and Substance Use Disorder Parity Task Force;
- A $11 million funding opportunity for the purchasing and distribution of the opioid overdose reversal drug - naloxone; and
- More than 60 medical schools will start requiring students to receive prescriber education in order to graduate.
In February, President Obama requested $1.1 billion from Congress to help fight the growing epidemic. The FDA also recently mandated that all immediate-release opioid painkillers contain a boxed warning.
CMS says the final rule does not inflict on the flexibility that states can provide managed care services, but rather ensures that Medicaid enrollees can access mental health and substance use services the same way they can access medical benefits.
According to the release, plans are now required to disclose any information on mental health and substance use disorder benefits, such as criteria for determining medical necessity, as requested by the agency under the rule.
The rule is scheduled to be publicly displayed online sometime tomorrow, March 30.
The HHS report released Tuesday suggests every year there would about 371,000 less people experiencing depression if all states were to expand Medicaid under the ACA. Secretary Burwell said the report "shows that Medicaid expansion is an important step states can take to address behavioral health needs, including serious mental illness and opioid and other substance use disorders."