On March 29, 2016 the Centers for Medicare and Medicaid Services (CMS) finalized the long-awaited rule applying mental health and substance use disorders parity to Medicaid and the Children’s Health Insurance Program (CHIP).

Mental health and substance abuse parity means that a health plan pays for treatment as it would if the patient was being treated for any physical disorder. When a plan has parity, it means that if you are provided unlimited doctor visits for a chronic condition like diabetes, the health plan must offer unlimited visits for a mental health condition such as depression.

Community Catalyst’s Health Policy Hub blog post on April 7, 2016 highlights the important features of the rule.

These provisions of the rule were finalized as proposed:

All mental health and substance use disorders benefits offered through Medicaid managed care organizations (MCOs) have to follow the new rules.
Medicaid programs can’t avoid the rules just because it costs more.
Managed Care Organizations must disclose how they decide if a treatment is medically necessary for substance use disorders or mental illness, and the MCOs must provide explanations when they deny coverage. States must also publicly post documentation of compliance with parity rules.
Learn more about the rules by reading the full Community Catalyst blog.

Although states have 18 months to come into compliance with the parity regulations, there are three things advocates can start to do now:

Get in touch with state health department and Medicaid officials. Advocates can highlight stories of Medicaid and CHIP consumers who aren’t getting the mental health and/or substance use disorders care they need and urge officials not to wait 18 months to bring the Medicaid program into compliance with parity rules. Consumers should not have to wait any longer for good care.
Continue advocacy for fuller implementation of Early, Periodic Screening, Diagnosis and Treatment (EPSDT). Given the establishment of the EPSDT benefit as a compliance standard for parity in CHIP and concerns about how EPSDT is implemented, advocates can continue to encourage state regulators to monitor EPSDT services. Advocates can also proactively engage providers about the importance of including age-appropriate substance use disorders and mental health screenings as a critical component of the EPSDT benefit.
Push for more data, reporting, and enforcement. Laws and regulations do not guarantee robust enforcement. Advocates can urge state officials to improve data collection and reporting systems about consumer experiences, including better tracking of parity complaints with state agencies. Most importantly, advocates can press state and federal officials to enforce parity in all Medicaid and CHIP programs.
Many thanks to Community Catalyst for the content of this article.