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Parity for Mental Health and Substance Use Disorder Benefits

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 published guidance and resources on Parity requirements. CMS also published guidance to remind States of their responsibility to comply with parity requirements.