The October Deadline for Compliance with Medicaid Mental Health Parity Requirements


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.