130 CMR, § 450.123 - Managed Care Compliance with Mental Health Parity
(A) MCOs, Accountable Care Partnership Plans,
SCOs, and ICOs, and their behavioral health subcontractors or third party
administrators, if any, must comply with and implement relevant provisions of
the Paul Well stone and Pete Domenici Mental Health Parity and Addiction Equity
Act of 2008 (the Federal Mental Health Parity Law), and implementing
regulations and federal guidance, which requires parity between mental health
or substance use disorder benefits and medical/surgical benefits with respect
to financial requirements and treatment limitations.
(B)
Annual Certification of
Compliance with Federal Mental Health Parity Law. Each MCO,
Accountable Care Partnership Plan, SCO, and ICO must annually review its
administrative and other practices, including the administrative and other
practices of any behavioral health subcontractors or third party
administrators, for compliance with the relevant provisions Federal Mental
Health Parity Law, regulations, and guidance.
(1) Each MCO, Accountable Care Partnership
Plan, SCO, and ICO must submit a certification signed by the chief executive
officer and chief medical officer stating that the entity has completed a
comprehensive review of the administrative practices of the entity for
compliance with the necessary provisions of State Mental Health Parity Laws and
Federal Mental Health Parity Law.
(2) If the MCO, Accountable Care Partnership
Plan, SCO, or ICO determines that all administrative and other practices were
in compliance with relevant requirements of the Federal Mental Health Parity
Law, the annual certification will affirmatively state that all relevant
administrative and other practices were in compliance with Federal Mental
Health Parity Law.
(3) If the MCO,
Accountable Care Partnership Plan, SCO, or ICO determines that any
administrative or other practices were not in compliance with relevant
requirements of the Federal Mental Health Parity Law, the annual certification
will state that not all practices were in compliance with Federal Mental Health
Parity Law, and will include a list of the practices not in compliance, and the
steps the entity has taken to bring these practices into compliance.
(C) A member enrolled in an MCO,
Accountable Care Partnership Plan, SCO, or ICO may file a grievance with
MassHealth if the member believes that services are provided in a way that is
not consistent with applicable Federal Mental Health Parity laws, regulations,
or federal guidance. Member grievances may be communicated for resolution
verbally or in writing to MassHealth's customer service contractor.
Notes
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