Helaine I. Fingold, Senior Counsel, and Kevin Malone, an Associate, in the Health Care and Life Sciences practice, in the firm’s Baltimore and Washington, DC, offices, co-authored an AHLA PG Alert, titled “The October Deadline for Compliance with Medicaid Mental Health Parity Requirements.”

Following is an excerpt:

October 2 represented a major milestone in the almost decade-long implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).1 In particular, most2 state Medicaid agencies were required to demonstrate their compliance by October 2 with the long-awaited final rule implementing MHPAEA (Final Rule),3 which was published by the Centers for Medicare & Medicaid Services (CMS) on March 30, 2016. Although MHPAEA does not apply to benefits for beneficiaries who receive services only through Medicaid fee-for-service (FFS), through a complex patchwork of legal authorities, states are required to implement the Final Rule's provisions for services provided through Medicaid managed care organizations (MCOs), Medicaid benchmark or benchmark-equivalent plans (Alternative Benefit Plans or ABPs), and the Children's Health Insurance Program (CHIP).

States manage and deliver physical and behavioral health benefits within their Medicaid and CHIP plans in different ways, such as using integrated managed care plans or behavioral health carve-outs through Prepaid Inpatient Health Plans (PIHPs) or Prepaid Ambulatory Health Plans (PAHPs). The Final Rule requires states to document MHPAEA compliance across their entire delivery system for covered beneficiaries. Further, because much of the MHPAEA compliance documentation process focuses on the collection of information documenting processes, strategies, evidentiary standards, and other factors used to apply non-quantitative treatment limitations (NQTL) (in writing and in operation), each entity involved in the delivery system must cooperate in providing information to the state. Due to these complexities that are unique to the Final Rule, MHPAEA compliance in Medicaid is certainly more complex than its application to the commercial market.

This alert describes the key requirements of the Final Rule that states were required to deliver on October 2 and discusses the likely next steps for CMS, states, and MCOs.

Jump to Page

Privacy Preference Center

When you visit any website, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalized web experience. Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.

Strictly Necessary Cookies

These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms. You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.

Performance Cookies

These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.