Today the Centers for
Medicare & Medicaid Services (CMS) released a State Health Official
(SHO) letter that provides guidance to states on a new
congressionally-mandated behavioral health coverage benefit for separate
Children Health Insurance Programs (CHIPs). This SHO provides guidance
to states with separate CHIPs on the actions necessary to implement the
requirements of section 5022 of the SUPPORT Act (effective October 24,
2019). The majority of states have elected to provide some behavioral
health coverage to their separate CHIP populations; however, states will
need to review their behavioral health benefit array in the context of this
new requirement.
States will now be
required to:
- Provide coverage of all the American Academy
of Pediatrics (AAP)/Bright Futures recommended behavioral health
screenings and all U.S. Preventive Services Task Force (USPSTF)
behavioral health recommendations with a Grade of A or B.
- Provide an array of behavioral health
benefits that is sufficient to treat a broad range of behavioral
health conditions.
- Cover Medication Assistance Treatment for
Opioid Use Disorders (OUDs) and tobacco cessation.
- Identify a strategy to facilitate the use of
validated age-appropriate screening tools. These tools are used to
detect a particular concern or condition.
- Identify a strategy to facilitate the use of
validated clinical assessment tools. These tools are used to
determine a diagnosis, evaluate the current level of functioning and
develop treatment recommendations.
- Submit a title XXI CHIP SPA to demonstrate
compliance with Section 5022 of the SUPPORT Act.
State Health Official (SHO) Letter: Access to Mental Health
and Substance Use Disorder Services for Children and Pregnant Women in the
Children’s Health Insurance Program
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