Improving Mental Health and Substance Use Care Access in Medicare and Medicaid
This Act reforms Medicare and Medicaid to improve access to integrated mental health and substance use disorder care. Medicare beneficiaries will face no coinsurance for specific integrated mental health services, and insurance plans must comply with parity requirements regarding benefits. The legislation also establishes a demonstration project to ensure Medicaid-enrolled children have access to prevention and early intervention services.
Key points
Waiver of coinsurance for Medicare beneficiaries receiving integrated mental health and substance use disorder services furnished on or after January 1, 2025.
Mandatory parity: Medicare Advantage and Medicaid plans must apply financial requirements and treatment limitations to mental health no more restrictively than to medical benefits.
Increased transparency: Insurance plans must report data on average wait times for behavioral health appointments and denial rates compared to physical health services.
Creation of a demonstration project to ensure Medicaid-enrolled children have access to integrated mental health and substance use disorder care services.
Implementation of audits of state Medicaid and CHIP programs to assess enforcement of mental health parity requirements.
Expired
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