The U.S. Centers for Medicare & Medicaid Services (CMS) has announced a new proposal that would require health plans offered through the federal and state-based marketplaces to cover mental health facilities and substance use disorder treatment centers.
The new proposal, announced Monday, would make these two types of facilities essential community providers (ECPs). It would also extend the current overall 35% provider participation threshold to federally qualified health centers (FQHCs) and family planning providers (FPPs).
ECPs mainly serve vulnerable populations. The federal government presently defines six types of providers as ECPs: FQHCs and look-alike facilities; FPPs; Ryan White HIV/AIDS Program Providers; Indian Health Providers; hospitals; and a handful of condition-specific facilities.
These provisions are part of the proposed 2024 Notice of Benefit and Payment Parameters proposed rule.
The move is meant to expand behavioral health care for a group of people who wouldn’t otherwise qualify — by need or age — for Medicare or Medicaid. For 2022, 14.5 million Americans enrolled in plans through the marketplaces, according to CMS.
“We know that access to affordable health care is a concern across the nation,” CMS Administrator Chiquita Brooks-LaSure said an announcement from the agency. “Continuing to propose policies that help make it easier for consumers to choose and maintain the health coverage that best fits their needs is vital. If finalized, this proposed rule does just that.”
CMS has rolled out several other proposed rules to increase behavioral health access in Medicare and Medicaid.
Some of these include loosening telehealth rules for behavioral health and changing supervision rules for specific types of behavioral health practitioners. The agency released its behavioral health strategy in April.
Another part of Monday’s proposed rule will allow for the federal and state marketplaces to implement a special enrollment period for those losing Medicaid coverage. It would allow enrollees to select a marketplace plan 60 days before or 90 days after their loss of Medicaid.
As many as 15 million Americans, including 6.7 million children, are at risk of losing Medicaid following the end of the federal public health emergency, according to the Georgetown University Health Policy Institute. The federal government paid state Medicaid programs higher rates if they made it easier to get on and keep Medicaid coverage in response to the coronavirus pandemic.
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