The Centers for Medicare & Medicaid Services (CMS) has decided to build long-term care (LTC) services into the fabric of a new regulation that will set standards for how Medicaid managed care plans and Children’s Health Insurance Program (CHIP) plans cover behavioral health care.
CMS has included LTC services in the definitions for “medical/surgical benefits,” “medical/surgical benefits,” “mental health benefits” and “substance use disorder benefits” in a new behavioral health parity final rule.
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CMS is preparing to publish the regulations, which explain how the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) applies to Medicaid managed care plans and CHIP plans, on Wednesday in the Federal Register.
Most states now hire outside-managed care organizations to run parts or all of their Medicaid programs.
The MHPAEA requires commercial health insurance plans, Medicaid managed care plans and CHIP plans that provide any mental health or substance use disorder benefits, along with medical benefits, to use comparable rules for providing the behavioral health benefits and the medical benefits.
The MHPAEA, and the new regulations, do not apply directly to Medicaid behavioral health services provided through traditional fee-for service arrangements.
In response to a draft of the Medicaid parity regulations, some insurers said CMS should encourage states to provide all Medicaid services, including behavioral health services, through a single managed care contract, to improve coordination of care. Other organizations, including Magellan Health Services Inc. (NYSE:MGL), a company that manages behavioral health services, said CMS should give states flexibility.
CMS says it will continue to let states decide whether to integrate behavioral health benefits with other health benefits or split the contracts.
In the earlier draft, CMS proposed excluding LTC services from the definitions it would be using for medical, mental health and substance use disorder benefits. ”A large majority of commenters opposed this approach,” CMS says.