On April 6, the U.S. Department of Health and Human Services (HHS) released a draft rule to implement federal parity legislation in Medicaid and the Children’s Health Insurance Program (CHIP). The proposed rule is available online.
We have been awaiting this rule ever since the original rule for large-group private insurance programs was released early in 2010. Both rules proceed from the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act passed in 2008, after being championed by Representative Patrick Kennedy and his father, Senator Ted Kennedy.
The new rule does not disappoint. Intended to extend parity of medical and behavioral health benefits and treatment limitations to Medicaid managed care programs, alternative benefit plans and CHIP, it will bring parity protection to an estimated 22 million additional Americans. Its major provisions include:
- Parity protection for enrollees under Medicaid managed care organizations, even in situations where mental health and substance use benefits are carved out of health benefits and administered separately. Although such carve-outs are beginning to gradually disappear in favor of integrated programs, many states still have them. Hence, this provision is extremely important for our field.
- Parity protection for enrollees under Medicaid alternative benefit plans, other than those covered by plans developed as a result of the implementation of state Medicaid Expansions under the Patient Protection and Affordable Care Act (ACA), who already had such protection.
- Parity protection for children and adolescents insured under CHIP, whether through a managed care organization or not, which also is a huge win for behavioral healthcare.
States will be given an 18 month period to comply with the new rule, once it is adopted in final form. Comments on the draft rule issued yesterday are due back to HHS by June 9.
Several other major points also are worth mentioning about the draft rule. These include: