Under the final rule, plans must disclose information on mental health and substance use disorder benefits upon request, including the criteria for determinations of medical necessity. The final rule also requires the state to disclose the reason for any denial of reimbursement or payment for services with respect to mental health and substance use disorder benefits.

 

This is one of CMS' latest efforts to increase access to and improve mental health services and care for low income individuals, especially in light of the opioid abuse epidemic, which constitute significant health risks and cost drivers in the Medicaid program.

 

On April 4, CMS released final updates to the Medicare Advantage and Part D Prescription programs through 2017 Rate. These updated policies seek to arrange stable payments to plans and improve the programs for plans that deliver high quality care for millions of seniors and people living with disabilities. CMS Acting Administrator Andy Slavitt stated, "with these policies, we will continue to see improvements in growth, affordability, benefits, and quality."

 

The new policies are designed to improve the accuracy of payment to Medicare Advantage plans that serve dual-eligible or low income beneficiary populations. The payment plan implements methodology changes to evaluate plan performance in order to better account for the costs associated with caring for these enrollees. According to CMS, a revised model for risk adjust payments will more accurately reflect the cost of care for dual-eligible beneficiaries. Another improvement of the new policies is the interim adjustment to the Star Ratings system, which will accurately reflect the socioeconomic and disability status of a plan's enrollees. CMS is also in the process of finalizing policies to encourage safeguards before distribution of opiod prescription at a pharmacy to combat over-utilization of opiods. 

HHS Health Equity Forum - April 7, 2016