Last week, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury released their final regulations that were expected to strengthen federal Mental Health Parity enforcement. and Addiction Equity Act (MHPAEA). As highlighted by the DOL, the final regulations, among other provisions, clarify that group health plans and health insurance providers that offer group or individual health insurance coverage each cannot use non-limiting treatment limits (NQTLs), such as prior authorization requirements or network adequacy. , which are more restrictive than those applied to medical and surgical health. It also requires planners and providers to collect and evaluate data on NQTLs and take reasonable action to address material differences in access. In addition, under the regulations, plans are required to provide reasonable benefits for mental health conditions such as routine treatment or treatment, treatment, service, or intervention indicated by independent standards. in general of current medical treatment.
Although the legislation represents an important step forward in the implementation of the MHPAEA, it is important to note that the legislation does it does not work directly on Medicaid or the Children’s Health Insurance Program (CHIP), which has an equity performance structure maintained by states and the Centers for Medicare & Medicaid Services (CMS) which unfortunately also has gaps and issues noticeable. (As noted in footnote 125 of the regulations, “the portion provided by the managed care agencies of Medicaid, CHIP, and the Medicaid Alternative Benefit Programs is subject to separate mental health regulations” (comp. at 42 CFR parts 438, 440, 456, and 457) ).
So where does this leave Medicaid and CHIP?
As you may recall, in September of last year, CMS released a Request for Comments on Budgeting Approaches to Align Mental Health Parity and Addiction Equity in Medicaid and CHIP. Our response, including a call to improve NQTL reporting and oversight — such as reviewing and improving Medicaid and CHIP pre-authorization processes — can be found here. Unfortunately, CMS has not yet proposed or finalized the same rules for Medicaid and CHIP. However, on the same day that the three agencies released their final rules related to equity for group health plans and health insurance providers, CMS released a Request for Comment on Templates for Documenting Compliance with MHPAEA in Medicaid and CHIP. This request comes on the heels of a news release released this summer reiterating the state’s responsibilities for managing managed care plans and reiterating the state’s commitment to properly manage its Medicaid and managed care systems. separate CHIP programs and compliance with existing federal parity requirements as well as recently completed access. and managed care laws focused on improving access to care in Medicaid and CHIP (a full summary of those laws including implementation timelines can be found here).
According to CMS’s request for comment, the new set of templates and instructional guidelines are intended to standardize, streamline and strengthen states’ efforts to demonstrate, and enable CMS to comply with, the requirements of equity in coverage and federal delivery of Medicaid and CHIP. benefits. CMS seeks initial feedback on study templates and guidelines before finalizing materials and seeks approval from the Office of Information and Regulatory Affairs before issuing templates and guidelines. A request for feedback, along with links to design templates and study guides and specific questions for feedback, can be found here. CMS requests that comments be submitted by email by October 29.
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