The Centers for Medicare and Medicaid Services are proposing new regulations that would require Medicaid to cover mental health services at the same level as other medical and surgical services. This rule would hold Medicaid to the standard established under a federal law passed in 2008. Regulations issued in 2013 are similar in that they already require most private health insurance plans to cover mental health services at the same level as medical and surgical. Officials with the National Association of Medicaid Directors are welcoming this rule, but warn that it will likely take years to see the full impact.
Medicaid has become the largest payer of mental health services in the country and this proposed rule will help to allow more people to get the care they need. Nearly 12 million visits made to United States hospital emergency departments in 2007 involved individuals with a mental disorder, substance abuse problem, or both.
Many people who participate in Medicare do not have adequate insurance protection against the cost of treatment for mental and substance abuse disorders. The new proposed rule will affect:
- copays, coinsurance, and out-of-pocket maximums
- Limitations on services utilization (limit on the number of inpatient/outpatient days that are covered
- Coverage for out-of-network providers
- Criteria for medical necessity determinations
The new proposed rule also would mandate that Medicaid programs provide a reason a beneficiary was denied treatment. The rule will be open for public comment through June 9.