The Centers for Medicare & Medicaid Services (CMS) has finalized a new rule that would add mental health facilities and substance use disorder treatment centers to the list of essential community providers (ECPs), in an effort to expand access to behavioral health services.
This new rule, which is part of the Notice of Benefit and Payment Parameters for 2024, expands the current overall 35% provider participation threshold to federally qualified health centers (FQHCs) and family planning providers (FPPs).
FQHCs and FPPs are two of six types of providers designated as ECPs.
“Adding mental health and substance use disorder facilities to the list of Essential Community Providers would be meaningful in a couple of ways,” Michelle Guerra, a senior consultant in population health and health equity at RTI Health Advance, previously told Behavioral Health Business. “First, it would expand access to behavioral health care for members on marketplace plans. And second, it sends a clear message that behavioral health is an essential type of health care, reducing stigma around behavioral health.”
The new rule also implements a special enrollment period for individuals losing their Medicaid or Children’s Health Insurance Program (CHIP) coverage to enroll in a federally facilitated marketplace and state-based marketplace, which will let enrollees to select a marketplace plan 60 days before or 90 days after their loss of Medicaid.
The new rule will affect the 14.5 million people who are enrolled in health plans through the marketplace, the bulk of whom are individuals who do not qualify for Medicare, Medicaid or CHIP coverage.
“We’ve made great progress with record insured rates, but affordable health care remains a concern across the nation,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “As we continue to work toward accessible and equitable health care for all Americans, the 2024 Notice of Benefit and Payment Parameters Final Rule we’re finalizing today will make it easier for consumers to access, choose and maintain the health coverage that best fits their needs.”
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