CMS wants to curb cost sharing for mental health in Medicare Advantage: 5 notes

Here are five things to know about the proposed rules for behavioral health services: 

1. CMS proposed limiting copayments to 20% for mental health specialty services, partial hospitalization and intensive outpatient, and outpatient substance use treatment. Current regulations allow plans to impose 30% to 50% cost sharing for these services, depending on the plan type.
   
   
2. The proposed rules would require plans to cover opioid treatment programs with zero cost share. Currently, plans can impose a 50% copay requirement.
   
   
3. The agency is seeking comments on applying a possible transition period to the proposed regulations to avoid disruptive changes.
4. Lawmakers have expressed concerns that Medicare Advantage plans may have narrow or inaccurate networks for behavioral healthcare, and impose stricter prior authorization requirements on behavioral healthcare compared to physical healthcare. 
   
   
5. In April, CMS finalized rules requiring Medicare Advantage plans to include adequate numbers of outpatient behavioral health providers in their networks. 

The proposed rule is open for comment until Jan. 27. Read the full proposed rule here.