CMS has released the final rule implementing legislation intended to put insurance benefits for patients with mental health and substance abuse disorders on par with those for other covered health problems, and the AAFP is urging the agency to amend the rule's language to ensure Medicaid and the Children's Health Insurance Program (CHIP) are included.
The final rule implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which ensures that plans that offer mental health and substance abuse benefits do not impose financial requirements and treatment limitations for the benefits -- including copays, deductibles and visit limits -- that are more restrictive than those for medical and surgical benefits.
In a Jan. 8 letter to CMS Administrator Marilyn Tavenner, M.A., the AAFP and 17 other organizations contend that the final rule doesn't go far enough. "The final rule explicitly does not apply to Medicaid and CHIP plans, leaving more than 43 million children without these protections," says the letter.
CMS needs to quickly issue regulations that apply the consumer protections in the MHPAEA final rule to Medicaid and CHIP plans, according to the organizations.
"Nearly one in five children in the United States suffers from a diagnosable mental disorder, but only 20 to 25 percent of affected children receive treatment," says the letter. "There are countless more children who face mental and behavioral impairments that do not meet the criteria for a diagnosis whose needs are not being met by the current system."
The lack of equity in Medicaid and CHIP plans results in "fragmentation between physical and mental health and makes the early identification and treatment of mental health problems in children and adolescents more difficult," says the letter. In addition, the organizations note, "Payment rates in Medicaid continue to be a barrier to access to mental health, and certain mental and behavioral health services for children and adolescents are not reimbursed at all."
It is vital that the same consumer protections offered by the MHPAEA that are enjoyed by those with private insurance also are available to Medicaid patients and children in the CHIP program, say the organizations. "Children and adolescents in these programs should receive the same protections from discrimination in mental health and substance use disorder treatment and recovery services as those who are privately insured."