New Mental Health and Substance Use Disorder Parity Rule for Medicaid announced by CMS

According to the National Survey on Drug Use and Health (NSDUH), there were approximately 43.6 million adults in the United States with mental Illness (18.2% percent of all U. S. adults) in 2014. 3.3 percent of all adults surveyed in 2014 had both a mental illness and a substance use disorder (SUD). “Illicit drug use” for purposes of defining an SUD, included the nonmedical use of prescription drugs without a valid prescription or use “simply for the experience or feeling the drugs caused.” (Center for Behavioral Health Statistics and Quality (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927 NSDUH Series H-50)).

In connection with the government’s push to halt the opioid epidemic, CMS issued a press release on March 29, 2016 that discussed the finalization of a rule that requires Medicaid and the Children’s Health Insurance Programs (CHIP) to provide greater coverage for mental health and substance use services. Prior to the October 3, 2009 implementation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), private health insurance plans generally provided less coverage for mental health conditions than for medical or surgical conditions. The MHPAEA changed that by mandating that group health plans and health insurance issuers treat mental health or substance use disorder benefits in the same manner as other medical/surgical benefits. CMS’ final rule that requires Medicaid and CHIP coverage for mental health and substance use services to be similar to coverage for medical and surgical benefits is long overdue. HHS Secretary Burwell stated: “Today’s rule eliminates a barrier to coverage for the millions of Americans who for too long faced a system that treated behavioral health as an unequal priority.” She further noted that “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.” (CMS News for Immediate Release, March 29, 2016)

CMS’ final rule provides states with flexibility in their delivery of services while ensuring that Medicaid enrollees requiring these services have access to them. CMS’ current opioid utilization initiatives signal a strong commitment to halting the opioid abuse epidemic facing our nation. We will continue to keep you advised of further developments.

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