The Centers for Medicare & Medicaid Services (CMS) disclosed its proposed rule to align mental health and substance use disorder benefits for low-income Americans with benefits required of private health plans and insurance on April 6, 2015. The proposed rule will ensure that mental health and substance use disorder benefits are no more restrictive than medical and surgical services.
“Currently, states have flexibility to provide services through a managed care delivery mechanism using entities other than Medicaid managed care organizations, such as prepaid inpatient health plans or prepaid ambulatory health plans. The proposed rule would continue this States flexibility in identifying varying delivery systems for Medicaid services provided to beneficiaries, while ensuring that enrollees of a Medicaid managed care organization receive the benefit of parity in services provided to them through these various means. States will be required to include contract provisions requiring compliance with parity requirements in all applicable contracts for these Medicaid managed care arrangements.
Under the proposed rule, plans must make available upon request to beneficiaries and contracting providers the criteria for medical necessity determinations with respect to mental health and substance use disorder benefits. The proposed rule also would require the state to make available to the enrollee the reason for any denial of reimbursement or payment for services with respect to mental health and substance use disorder benefits.”
The deadline to submit comments on the proposed rule is June 9, 2015.
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