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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Public Comments on Medicaid Managed Care Due Monday; National Council Releases Template

July 22, 2015 | Medicaid | Comments
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The public comment period for a new proposed rule on Medicaid managed care closes Monday, July 27. The National Council today is releasing a template comment letter for member organizations and other stakeholders to draw from in submitting their own comments.

The proposed rule makes extensive updates to managed care plans operating under Medicaid and the Children’s Health Insurance Program (CHIP).  This is the first major update to applicable regulations since 2003, and it seeks to align the managed care regulations across Medicaid, Medicare and the private market. In recent years, states have continued to expand the use of managed care to include more Medicaid enrollees, with far-reaching effects on individuals living with these conditions. Given Medicaid’s unique role in serving Americans living with mental illness and addictions, it is crucial that managed care arrangements provide sufficient and appropriate protections for this complex population. Prior Medicaid managed care regulations have not kept pace with the fast-moving changes in our delivery system, and CMS’ proposed updates to these regulations are a welcome step toward bringing our managed care delivery system into the 21st century.

The National Council’s comments touch on key elements of the rule that will affect mental health and addiction treatment providers. Among other recommendations, we request that the rule be revised to:

  • Clarify the proposed exception to the IMD exclusion. The regulation proposes to allow managed care plans to include within their capitated rates the cost of serving beneficiaries in certain residential or inpatient settings that would otherwise be excluded. The National Council urges CMS to clarify that this applies to both mental health and addiction treatment settings.
  • Bolster network adequacy requirements. The proposed rule would require states to establish network adequacy standards that ensure patients’ access to certain types of specialty providers such as mental health and addiction providers. The National Council supports these requirements and offers several suggestions for strengthening the rules so as to maximize the inclusion of mental health and addiction facilities and providers in plan networks.
  • Strengthen formulary requirements. The National Council urges CMS to expand upon the formulary requirements outlined in the rule by establishing clear safeguards for patients who need access to off-formulary medications and strengthening information disclosure requirements so as to provide patients with the information they need to make the right plan selection.
  • Clarify plans’ ability to provide health IT incentive payments to behavioral health providers. The rule permits managed care plans to include electronic health record incentive payments for behavioral health providers within their capitated rate. The National Council strongly supports this proposal and requests additional clarification for states and plans on how this funding may be used.

The National Council has also made our comments available in a word document as a template to assist members who wish to submit their own comments in response to the proposed rule.

Comments are being accepted through 5:00 p.m. eastern time on Monday, July 27. To submit comments electronically, visit the page for this proposed rule on; then click “Comment Now” in the upper right corner.