This final rule will address the application of certain requirements set forth in the Public Health Service Act, as amended by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, to coverage offered by Medicaid managed care organizations, Medicaid Alternative Benefit Plans, and Children's Health Insurance Programs. Health [23] MCO B does not require prior authorization in person but instead provides that authorization for an inpatient admission may be obtained from MCO B over the phone. Some commenters were concerned that individuals being served entirely in the FFS environment are being denied the same protections as individuals who get some portion of their care through a managed care arrangement. Based on the commenter noting that services may be driven into the MCO and in light of our policy in this final rule, we reviewed the proposed 438.920(b)(2) and discovered that proposed (b)(2) was written to indicate a state responsibility only when some services are carved out of the MCO. [1920] Removing quantitative limits on treatment may be particularly beneficial for individuals with severe mental illness and substance use disorders who may need to receive more services than the average individual. 25;335(4):226-32 (Jul. American Journal of Public Health,63(5):686-8 (May 1972). Commenters believed that states need to review both the medical/surgical criteria and the MH/SUD criteria to determine full compliance with this rule. as pregnant individuals may suffer from life-threatening conditions such as severe preeclampsia, newly diagnosed cancer requiring prompt treatment, and intrauterine infections,[33] L. 105-33, enacted on August 5, 1997) (BBA) added sections 1932(b)(8) and 2103(f)(2) of the Act to generally apply certain aspects of MHPA, including the provisions of section 2726 of the PHS Act, to Medicaid MCOs and CHIP benefits. Nothing in this final regulation prohibits states from including additional MH/SUD services in their state plan or in managed care arrangements. The commenters encouraged CMS to ensure that a beneficiary's entire benefit package of items and services meets parity standards, regardless of the entity or program that is responsible for financing the care, stating that this approach would ensure equitable access to MH/SUD by beneficiaries across all programs, and would also support issuers and states in meeting compliance standards. 2022 Breaking Media, Inc. All rights reserved. 38 U.S.C. Sec. 35. Section 2103(c)(6) of the Act requires that state CHIP plans that provide both medical and surgical benefits and MH/SUD benefits shall ensure that financial requirements and treatment limitations for such benefits comply with mental Start Printed Page 18391health parity requirements of the PHS Act (referencing renumbered section 2726(a) of the PHS Act) to the same extent as such requirements apply to a group health plan. [23] Document Drafting Handbook 106(a). Parity This paragraph (c) details the application of the parity requirements for aggregate Start Printed Page 18443lifetime and annual dollar limits. One issue was the actuarial soundness requirements, which mandate that MCO payments be based on services as covered under state plans. ABP coverage offered by States must comply with the requirements of this section no later than October 2, 2017. For instance, Federal funds available to the Departments of Labor, Health and Human Services, and Education are subject to an appropriations restriction known as the Hyde Amendment. Congress has included the Hyde Amendment in those agencies' annual appropriations legislation for more than forty years. Comment: Some commenters recommended that the states should submit documentation beyond state plan assurances to show how they plan to meet parity requirements. Response: We believe that payment to providers is addressed through our discussion of NQTLs in this rule. Specifically, they found that prior to the implementation of the state parity law; approximately 5 percent of beneficiaries with any behavioral health visits exceeded the specified limits of that plan. 2016-06876 Filed 3-29-16; 8:45 am], updated on 4:15 PM on Wednesday, November 9, 2022, updated on 8:45 AM on Wednesday, November 9, 2022, 116 documents The Balanced Budget Act of 1997 (Pub. These estimates reflect the requests for medical necessity determination criteria's disclosure procedures by beneficiaries or contracting providers. In addition, 438.406(b)(4) provides that the enrollee and his or her representative must be included in the appeals process. With the exception of these revisions, as indicated in the response to comments, we are finalizing the provisions regarding NQTLs at 438.910(d), 440.395(b)(4), and 457.496(d)(4) and (5) as proposed. Ann. It asserts the human rights of infants born after a failed attempt to induce abortion. Responsibility for interpretation and enforcement of ERISA is divided among the Department of Labor, the Department of the Treasury (particularly the Internal Revenue Service), and the Pension Benefit Guaranty Corporation. Accordingly, to determine the anticipated impact of mental health parity in cost in future years, we applied growth in Medicaid and CHIP expenditures from the mid-session review of the President's FY 2016 budget to this cost. Response: This final rule neither sanctions nor prohibits aggregate lifetime and annual dollar limits; this rule merely provides the standards for applying parity requirements to such limits if the limits are otherwise authorized. ICRs Regarding Contract Requirements (438.6(n)), 7. The Mental Health Parity and Addiction Equity Act (federal parity law) was enacted in 2008 and requires insurance coverage for mental health conditions, including substance use disorders, to be no more restrictive than insurance coverage for other medical conditions. This allows for a broad array of services to be available under EPSDT such as rehabilitative and therapy services, counseling, personal care services, immunizations, periodic comprehensive well-child checkups and screenings for vision, hearing, and dental care, even if not covered for adults under the Medicaid state plan. Indeed, delaying the issuance of this rule would increase the risk to their health and lives and put care out of reach for some pregnant veterans and CHAMPVA beneficiaries entirely. 50. If questions arise about the appropriateness of criteria that are being used to apply NQTLs to MH/SUD benefits, we will consider whether additional subregulatory guidance or further rulemaking is needed. Federal government websites often end in .gov or .mil. . The Unfunded Mandates Reform Act of 1995, see 2 U.S.C. MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT documents in the last year, 887 When reference is made in this paragraph (b) to a level of a type of financial requirement or treatment limitation, level refers to the magnitude of the type of financial requirement or treatment limitation. [54] (2) If, for a type of financial requirement or quantitative treatment limitation that applies to at least two-thirds of all medical/surgical benefits in a classification, there is no single level that applies to more than one-half of medical/surgical benefits in the classification subject to the financial requirement or quantitative treatment Start Printed Page 18441limitation, the State may combine levels until the combination of levels applies to more than one-half of medical/surgical benefits subject to the financial requirement or quantitative treatment limitation in the classification. We remove 17.272(a)(65) that excludes abortion counseling from the CHAMPVA program. ACOG Practice Bulletin No. This will include the review of the MCO contracts and SPA documents, as well as any documentation of the parity analysis the state has done to determine that their system and/or benefit design meet the requirements of this rule. Addition of various requirements for a pension plan to be tax-favored ("qualified"), including: The plan must offer retirees the option of a joint-and-survivor annuity, Plan benefits may not discriminate in favor of officers and highly paid employees. Under our proposed amendments to part 438, for parity standards to apply, a beneficiary must be enrolled in an MCO, as defined in 438.2, under a Medicaid contract. Levit KR, Mark TL, Coffey RM, Frankel S, Santora P, Vandivort-Warren R, Malone K. Federal spending on behavioral health accelerated during recession as individuals lost employer insurance. As a part of the review process, we will work closely with states to ensure compliance with the parity requirements and assist states in their efforts to address any inconsistencies discovered during the review process.Start Printed Page 18406. We noted in the proposed rule that the MHPAEA final regulations at 146.136(c)(2)(ii) set forth the following classifications of benefits: inpatient in-network; inpatient out-of-network; outpatient in-network; outpatient out-of-network; emergency care; and prescription drugs. Employees and retirees who were promised lifetime health coverage may be able to enforce those promises by suing the employer for breach of contract, or by challenging the right of the health benefit plan to change its plan documents to eliminate promised benefits. Response: As states will be required to report publicly, under 438.920(b)(1), how they are complying with the requirements in this final rule in cases where not all benefits are provided through the MCO, we believe that MCOs will be able to see the information just as other stakeholders do. Only official editions of the We proposed to eliminate 456.171 (namely, the current regulatory language that requires Medicaid agencies to evaluate each applicant's or beneficiary's need for admission into inpatient services in a mental hospital by reviewing and assessing the hospital's medical, psychiatric and social evaluations). If you wish to comment, please identify the rule (CMS-2333-F) and submit your comments to the OMB desk officer via one of the following transmissions: Mail: OMB, Office of Information and Regulatory Affairs; Attention: CMS Desk Officer. We note that CMS proposed changes to 438.206 and 438.207 that we believe are consistent with the intent of these final rules in CMS-2390-P Medicaid and CHIP Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability. 2008 Dec 24;300(24):2879-85. Abortion in the United States Am. 128 Obstetrics & Gynecology 447 (2016) (finding a 26.6 percent increase in maternal mortality rates between 2000 and 2014). Therefore, we will not approve any Waivers of the parity requirements set forth in this final regulation in a request for an 1115 Waiver. However, we believe that we provide adequate discussion of the similarities and differences in the use of terms in Medicaid and commercial plans in the text of this regulation and other regulations governing Medicaid, CHIP and the commercial health insurance market. 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