CMS Requests Public Comment on the Processes for Assessing Compliance with Mental Health Parity and Addiction Equity in Medicaid and CHIP

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Open for Comment: Questions on Processes for Assessing Compliance with Mental Health Parity and Addiction Equity in Medicaid and CHIP

The Centers for Medicare and Medicaid Services (CMS) is seeking public comments on a set of questions regarding processes for assessing compliance with mental health parity and addiction equity requirements in Medicaid managed care arrangements, Medicaid alternative benefit plans (ABPs), and the Children’s Health Insurance Program (CHIP).

Comments must be submitted to the following email address by December 4th, 2023, to receive full consideration: MedicaidandCHIP-Parity@cms.hhs.gov.

The questions for comment are focused on the following topics:

1. Model formats (e.g., templates) and key questions to consider for improving efficiency and effectiveness of review of documentation of compliance with parity requirements in Medicaid managed care arrangements, Medicaid ABPs, and CHIP,
2. Processes that states and managed care plans use to determine whether existing coverage policies are comparable for MH and SUD compared to medical and surgical benefits,
3. Key issues to focus on in reviewing policy or coverage documents that may indicate potential parity compliance issues in Medicaid managed care arrangements, Medicaid ABPs, and CHIP,
4. Which non-quantitative treatment limits (NQTLs) and benefit classifications should be prioritized for review,
5. What criteria should be used for identifying high priority NQTLs for review,
6. Measures or datapoints or other information that could help identify potential parity violations in Medicaid managed care arrangements, Medicaid ABPs, and CHIP,
7. How data on these or other recommended measures should be collected,
8. Potential follow-up protocols and corrective actions to take when measures indicate a potential parity violation in Medicaid managed care arrangements, Medicaid ABPs, and CHIP,
9. Additional processes that should be considered for assessing compliance with Medicaid and CHIP parity requirements, e.g., random audits,
10. Which MH conditions and SUDs are more prevalent among enrollees in Medicaid MCOs, Medicaid ABPs, and CHIP and barriers to accessing treatment for these conditions,
11. Which MH conditions and SUDs and types of treatment are at risk of not being covered in compliance with parity requirements for Medicaid managed care arrangements, Medicaid ABPs, and CHIP?