The Centers for Medicare and Medicaid Services (CMS) is seeking public comment on how to strengthen mental health and substance use disorder parity — i.e., the equal treatment of those services as compared to other medical services — in Medicaid and the Children’s Health Insurance Program (CHIP).

The agency is seeking to improve compliance with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and align Medicaid and CHIP with recently issued rules for private-sector health plans. Ultimately, any proposed rules would apply to Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and CHIP. Generally, the parity requirements under the MHPAEA do not apply to benefits under traditional fee-for-service Medicaid.

CMS is asking for comment on the following questions to assess and potentially update its current compliance processes in light of recent amendments to the MHPAEA and subsequent regulations:

1. What templates can be used to streamline the review of compliance documentation?
2. What are the key questions that should be asked to improve the efficiency and effectiveness of these reviews?
3. How do states and managed care plans assess parity between mental health and substance use disorder benefits and other medical benefits?
4. What key issues indicate potential parity violations?
5. What measures or data can reveal potential parity violations?
6. How should data be collected?
7. What follow-up protocols and corrective actions are advised for potential parity violations?
8. What additional methods, like random audits, could improve parity compliance?
9. Which mental health or substance use disorder conditions are most common in Medicaid MCOs, ABPs, or CHIP, and what are the barriers to treatment?
10. Are there specific mental health or substance use disorder conditions or treatments at risk of non-compliance in Medicaid plans?

Comments, which are for information and planning purposes only, should be submitted by Dec. 4, 2023.

See our blog post for more information on the recent proposed rules aimed at enhancing mental health parity compliance and our explainer for an overview of mental health parity in Arkansas.