By Annette M. Boyle
A new rule from the federal government requires Medicaid and Children's Health Insurance Program plans to adhere to the same standards as private insurers when it comes to coverage of mental health and substance abuse services.
The new regulations build upon the Mental Health Parity and Addiction Equity Act of 2008, which required private plans to provide mental health and substance abuse treatment benefits comparable to their medical and surgical benefits. Concerns have continued to arise, however, about whether health plans--particularly those on the Affordable Care Act exchanges--are actually compliant with the mandate.
The finalized rule requires Medicaid and CHIP plans to disclose information on mental health and substance abuse benefits upon request--including the criteria for determinations of medical necessity--and requires the state to disclose the reason for any denial of reimbursement or payment for mental health and substance abuse benefits.
"This rule will also increase access to evidence-based treatment to help more people get the help they need for their recovery and is critical in our comprehensive approach to addressing the serious opioid epidemic facing our nation," Department of Health and Human Services Secretary Sylvia Mathews Burwell said in an announcement.
The new rule comes as the Obama administration announced another initiative to address the opioid addiction epidemic, which is intended to increase access to medication-assisted treatment for individuals with opioid addiction.
Even more people would be covered through the new parity rule, however, if the remaining states expanded Medicaid eligibility, according to a new government report. It notes that an estimated 1.9 million uninsured people with substance abuse disorders or mental illnesses would qualify for Medicaid under the Affordable Care Act, but live in states that have not expanded the program.