If ending behavioral health discrimination were a race, it would surely be a marathon. One step at a time, progress has been made to ensure that treatment for mental health and substance use disorders is covered at parity, or equally to other forms of medical treatment under health insurance plans. As we reported last week, these wins are not yet enough to guarantee equality. The odds are still stacked against consumers with behavioral health needs.
But we moved one huge stride closer to the finish line when the federal government released a proposed regulation earlier this month spelling out how mental health and substance use disorders parity standards apply to Medicaid and the Children’s Health Insurance Plan (CHIP).
The new regulation to implement the 7-year-old Mental Health Parity and Addiction Equity Act will help an estimated 21 million Medicaid beneficiaries and 850,000 CHIP beneficiaries get better access to care.
The parity regulation, when finalized, will apply to CHIP, all versions of Medicaid managed care and partially to alternative benefit plans (ABP) in Medicaid expansion, and will protect consumers who are enrolled in those programs.
With the stakes so high, let’s look at the highlights of the proposed regulation:
- All mental health and substance use disorders benefits offered through Medicaid managed care organizations (MCOs) are subject to parity requirements, regardless of how the services are delivered. This means if a Medicaid MCO contracts these benefits to a behavioral health management company, the overall plan is still responsible for ensuring services comply with parity.
- Copayments, deductibles and any limits on the number of visits or length of treatment cannot be more restrictive for behavioral health services than those applied to most medical/surgical benefits.
- Other health plan rules, policies or practices that cannot be measured by a dollar figure or number, such as prior authorization, also must meet the parity standard.
- Plans must be more transparent about their policies. Medical necessity determination criteria for substance use and mental health benefits must be made available and plans must provide explanations when services are denied.
- All CHIP services, regardless of whether delivered through managed care or fee-for-service must comply with parity.
For the policy wonks in the audience, check out Tim Jost’s blog on Health Affairs for a more in-depth rundown of what the proposed parity regulation covers.
With so much good news to celebrate, one might wonder whether we’re sprinting toward the parity marathon finish line with fists raised in victory. Of course, this race won’t be won so easily.
Here are just a few roadblocks that still stand in the way:
- We are likely looking at two years or more before Medicaid enrollees will see the full benefits of this parity regulation. In addition to a comment period, the final rule will not go into effect until 18 months after it is finalized.
- Enforcement must be stepped up. We are heartened to see that the proposed regulation outlines consequences including the possible withholding of federal Medicaid matching funds for states that aren’t in compliance with parity rules. But greater analysis of outcomes for behavioral health consumers on the ground is needed, including better data collection and reporting of consumer parity complaints with state agencies. As we’ve seen in private insurance, parity is not guaranteed by laws and regulations alone—how rigorously these laws are enforced contributes to their efficacy in ending behavioral health discrimination.
- The parity regulation does not change the fact that the Mental Health Parity and Addiction Equity Act by design excludes fee-for-service Medicaid and all of Medicare. Behavioral health equity will not be complete until these programs are subject to the same standards as private insurance and Medicaid managed care.
The comment period for the proposed regulation is open through June 9. Community Catalyst will be submitting comments in response to the proposed rule. We will also provide template comments for state advocates who are interested in weighing in – stay tuned!