CMS should provide more oversight of Medicaid managed care organizations to ensure such operations are complying with mental health parity standards, according to the American Hospital Association (AHA). In a letter to CMS, the AHA noted that an April 2015 Proposed rule (80 FR 19418, April 10, 2015) to bring Medicaid and the Children’s Health Insurance Program (CHIP) into compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) (P.L. 110-343) was important, but needed equal applicable across all the states.
Parity requirements
The Mental Health Parity Act (MHPA) (P.L. 104-204), among other requirements, provides that annual and lifetime dollar limits on mental health benefits in group health plans cannot be lower than dollar limits for traditional medical and surgical benefits. The parity requirements were amended by the MHPAEA, which requires commercial health plans that offer mental health or substance use disorder (MH/SUD) benefits to provide them at parity with their medical/surgical benefits, and a Final Rule (78 FR 68240, November 13, 2013).
The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) further extended the obligation by mandating that the parity requirements reach qualified health plans (QHPs) established by the ACA, and Medicaid non-managed care benchmark and benchmark equivalent plans (see Mental health coverage: is parity the point?, Health Law Daily, April 6, 2015).
Under the April Proposed rule, the CHIP program would need to satisfy all of the parity requirements imposed on the Medicaid program (see CMS Proposed rule would extend mental health parity to Medicaid MCOs, Health Law Daily, April 10, 2015).
Issues
The AHA asked CMS to address the following five issues for all state programs: (1) oversight of state and MCO compliance with parity assessment standards; (2) parity assessments standards and benefit classifications; (3) state MCO capitation rates; (4) state responsibility and stakeholder consultation; and (5) behavioral health “carve outs.”
The AHA strongly recommended that CMS exert greater oversight to ensure that both state governments and the MCOs operating in the states comply with the MHPAEA parity standards. In addition, the AHA supported CMS’ proposal to require that state managed care contracts comply with parity standards regardless of whether MH/SUD services are provided in a full-risk MCO or other managed care arrangement, such as behavioral health “carve out” plans.
The AHA also expressed concerns that the lack of access to mental and behavioral health providers for Medicaid and CHIP beneficiaries could impede CMS’ goal to align the two health programs with commercial markets regarding parity assessments. Moreover, CMS’ proposal failed to address in-and out-of-network providers.