Medicaid managed care programs must comply with parity requirements for mental health (MH) and substance use disorder (SUD) benefits, including regulatory requirements at 42 CFR § 438.3(n) and subpart K. These regulations require States to ensure that all services delivered to enrollees of a managed care organization (MCO) are provided in compliance with Federal parity requirements, including that financial requirements, such as coinsurance or copayments, and treatment limitations imposed on MH or SUD benefits may not be more restrictive than those applied to substantially all medical or surgical benefits in a classification of benefits (i.e., inpatient, outpatient, emergency care and prescription drugs).
States must submit documentation of compliance with parity requirements (i.e., parity analyses) to CMS in accordance with 42 CFR § 438.3(n)(2) and 42 CFR § 438.920(b)(2). States must also effectively monitor parity requirements as part of their program monitoring activities as required in 42 CFR § 438.66 and to enable compliance with § 438.920(b)(2). Additionally, States should provide documentation of compliance with these requirements, including the States’ and MCOs’ parity analyses, to the general public and post this information on the State Medicaid website in accordance with 42 CFR § 438.920(b)(1).
CMS developed reporting templates and accompanying instructional guides to assist states and health plans (i.e., managed care plans) with ensuring compliance with these parity requirements, and to support consistent and transparent information to CMS documenting this compliance. CMS strongly encourages all states and plans to utilize these resources for current submissions; we believe optional use will allow users to become familiar with the content and functionality of these workbooks. CMS anticipates requiring use of these templates in the future.
CMS published guidance and resources, including the reporting templates are available on the Medicaid and CHIP Parity webpage. CMS also published guidance to remind States of their responsibility to comply with parity requirements.