By Susan L. Smith, JD, MA
States with a separate CHIP must submit a CHIP state plan amendment (SPA) to demonstrate compliance with the provisions of SUPPORT ACT section 5022, including coverage of behavioral health screening, prevention, diagnostic, and treatment mental health services.
CMS has issued a letter to state health officials describing the provisions of section 5022 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) (P.L. 115-271) and providing guidance to states that have a separate Children’s Health Insurance Program (CHIP) (Title XXI). States with a separate CHIP must submit a CHIP state plan amendment (SPA) to demonstrate compliance with the provisions of section 5022, including coverage of behavioral health screening, prevention, diagnostic, and treatment mental health services, strategies to facilitate use of appropriate screening and assessment tools as well as compliance with the requirement that the services are provided in a culturally and linguistically appropriate manner. This requirement applies to all CHIP eligible populations regardless of type of coverage elected by the state under a separate CHIP as well as pregnant women (CMS State Health Official Letter, SHO# 20-001, March 2, 2020).
Screening and preventive services. States will be required to provide coverage of all of the developmental and behavioral health related screenings and preventive services recommended for children from infancy to adolescence by the American Academy of Pediatrics’ (AAP’s) in its current version of the Bright Futures periodicity schedule. In addition, states will be required to provide coverage of clinical preventive services for children and adults, including pregnant woman recommended by the U.S. Preventive Services Task Force (USPSTF). States will be required to specify the periodicity schedule they have adopted for children. States must ensure that the types of screening and preventive services provided are at least comparable to the current version of the AAP/Bright Future standards. States may provide other types of behavioral and mental health screenings and preventive services for a range of behavioral conditions, beyond the required services. Behavioral health screening tools must be validated and age appropriate. States will be required to identify a strategy for incorporating and facilitating the use of age appropriate, validated screening tools for children and pregnant women in primary care settings such as covering the costs of administering the tools and the costs associated with purchasing the tools.
Treatment services and clinical assessment tools. States are required to demonstrate that its behavioral health benefit package are sufficient to treat a broad range of behavioral health symptoms and disorders and cover medication-assisted treatment and tobacco cessation benefits. In addition, states must identify a strategy to facilitate the use of validated clinical assessment tools for determining the most appropriate services for child and pregnant women experiencing behavioral health issues. States will be required to describe their behavioral health services in the state plan, including the amount, duration, and scope of each benefit for CMS to determine whether their benefits and levels of care are sufficient to treat a broad range of behavioral conditions. All states will be required to identify a strategy for facilitating the use of age-appropriate, validated screening and assessment tools for children and pregnant women in primary care settings.
Delivery of culturally and linguistically appropriate services. Section 5022(b)(2) of the SUPPORT Act requires behavioral health coverage be delivered in a culturally and linguistically appropriate manner regardless of the delivery system. Guidance for the provision of linguistically appropriate services is provided in CHIP regulations at 42 C.F.R. §§457.340(c), 457.1207, and 457.1230(a).
Access to care. States must adhere to existing CHIP rules at 42 C.F.R. §§457.495 and 457.1230 that provide that states ensure access to covered services, monitor and treat enrollees with chronic, complex or serious medical conditions, and timely process decisions related to prior authorization of services. In addition, they must continually improve access to high-quality, evidence-based treatment and maintaining an array of behavioral health benefits.
Distinction of the SUPPORT Act requirements. The SUPPORT Act’s requirements are distinct existing CHIP mandatory requirements under which behavioral health services were optional prior to the SUPPORT Act. The SUPPORT Act requirements are also distinct from the Mental Health Parity and Addiction Equity Act (MHPAEA) (P.L.110-343), which does not mandate behavioral health coverage.
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