Policy wonkish, but important....
States that provide Medicaid services through a managed care organization are already required to ensure that the MCO complies with the MHPAEA. A number of states, however, that provide medical/surgical services through an MCO carve out mental health and substance use disorder services and provide them through another arrangement, such as a prepaid inpatient health plan (PIHP) (This is Michigan) or prepaid ambulatory health plan (PAHP), or they provide them through fee for service (FFS).
What’s In The Proposed Rule?
The proposed rule provides that services provided in these ways must, when combined with services provided through an MCO, comply with the MHPAEA. A state can either modify its MCO contracts to ensure that MHPAEA requirements are met, or it can itself perform a parity analysis to ensure that parity requirements are met considering all elements of the delivery system. Either way, compliance must be publicly documented within 18 months of the finalization of the rule. States are required to develop actuarially sound capitation rates to ensure that MCOs, PIHPs, and PAHPs are compensated for the mental health services they provide, again within 18 months of the final rule date.
The proposed rules also require Medicaid alternative benefit plans (ABPs), which include benchmark and benchmark equivalent plans and CHIP plans, regardless of whether they are provided in MCO or non-MCO programs, to meet the same requirements as those governing MCOs, PIHPs, and PAHPs. CHIP programs that provide full coverage of early and periodic screening, diagnostic, and treatment (EPSTD) benefits are deemed to meet parity requirements. ABP benefits provided only through a FFS delivery system are not subject to certain parity requirements, including those covering lifetime and annual dollar limits on benefits.