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Mental Health (MH) and Substance Use Disorder (SUD) Parity


NH DHHS Parity Compliance Activities in 2018
now available.

For questions or suggestions, email: nhparity@dhhs.nh.gov

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires health insurance carriers to achieve coverage parity between benefits for mental health/substance use disorders (MH/SUD) and medical/surgical benefits, especially with regard to financial requirements and treatment limitations. On March 30, 2016, the Centers for Medicare and Medicaid Services (CMS) issued a final rule (the “Parity Rule”) at 42 USC part 438, subpart K to strengthen access to mental health (MH) and substance use disorder (SUD) services for services provided through Medicaid Managed Care Plans, Children’s Health Insurance Plans, and Alternative Benefit Plans, aligning such public coverage with the protections already required of private health plans. (Hereinafter MHPAEA and the Parity Rule shall be referred to collectively as the “Parity Law.”)

In summary, the Parity Rule requires Medicaid Managed Care Plans, Children’s Health Insurance Plans, and Alternative Benefit Plans to ensure that they are not placing limits on access to MH or SUD services that are not similarly applied to medical/surgical services. To ensure that inappropriate limits/restrictions were not being placed on MH/SUD services, the Parity Rule required the New Hampshire Department of Health and Human Services (“NH DHHS” or “Department”) to conduct a parity analysis for Calendar Year 2016 (CY 2016) and submit the results of its analysis to CMS no later than October 2, 2017.

This website is intended to provide information about NH’s Medicaid Program Parity Analysis process. Stakeholder feedback is invited and encouraged, as are questions about the Parity Analysis process.

For questions or suggestions, email: nhparity@dhhs.nh.gov


NH DHHS Ongoing Parity Compliance Activities
Although the Parity Rule does not require ongoing parity reporting by the states, NH DHHS has included parity compliance, analysis, and reporting provisions in the Medicaid Managed Care contracts between NH DHHS and the managed care organizations with which it contracts. Pursuant to the parity provisions in the Medicaid Managed Care contracts, NH DHHS plans to report annually on Medicaid managed care parity compliance beginning on September 30, 2019.


NH DHHS Parity Analysis Documents



NH DHHS Parity Compliance Activities in 2018

At the conclusion of the October 2, 2017 Compliance Report, NH DHHS stated that although the Department’s required parity analysis had determined that the NH Medicaid Program was in compliance with the Parity Rule, “the Department’s work on ensuring parity between mental health/substance use disorder services and medical/surgical services is far from over.” Referring to the NH DHHS Compliance Monitoring Plan included as Appendix D to the October 2, 2017 Compliance Report, NH DHHS stated that it “will be conducting additional parity analysis activities over the next year to ensure appropriate follow-up for any indications of parity noncompliance.” Following the submission of the October 2, 2017 Report, NH DHHS began the implementation of the NH DHHS Compliance Monitoring Plan by requesting additional information and analysis from the Plans as required by the parity provisions in the Medicaid Managed Care Contracts between NH DHHS and the Plans.

The ongoing parity compliance monitoring process that began in October 2017 was an iterative process during which NH DHHS requested additional information and further analysis from the Plans and provided access to national parity expertise to assist the Plans with the requested additional information and analysis of the Calendar Year 2016 parity data. During the period from December 2017 to April 2018, the Plans submitted the requested information. NH DHHS reviewed the additional information provided and sent a final set of follow-up questions to the Plans, to which the Plans responded.

NH DHHS reviewed the responses, noting those responses that were sufficient and requesting further information or responses as necessary. At the conclusion of the process described in this section, NH DHHS released a final parity compliance report for each Plan on December 31, 2018 covering CY 2016: NH DHHS Parity Compliance Report for New Hampshire Healthy Families for Calendar Year 2016 (December 31, 2018) Adobe Acrobat Reader Symbol and NH DHHS Parity Compliance Report for Well Sense/Beacon Health Plan for Calendar Year 2016 (December 31, 2018) Adobe Acrobat Reader Symbol – collectively referred to as the “2018 Parity Reports.” The purpose of the 2018 Plan Parity Reports is twofold: The first purpose is to fulfill NH DHHS’s responsibility to complete an independent review of the data and analysis submitted by each plan in order to validate both the parity analysis conducted by the plan and the plan’s conclusion that it was compliant with requirements of the Parity Rule for CY 2016. The second purpose is to identify any areas of concern with regard to ongoing parity implementation and compliance by the Plans. The iterative process utilized by NH DHHS and the Plans resulted in the resolution of a significant number of NH DHHS issues, leaving only a limited number of questions related to the Inpatient and Outpatient Service Classifications. There were no outstanding parity questions related to the Emergency and Pharmacy Service Classifications.


NH DHHS Parity Compliance for Calendar Year 2016
On July 3, 2017, NH DHHS required each of New Hampshire’s two Medicaid Managed Care Health Plans -New Hampshire Healthy Families and Well Sense/Beacon Health Plan (collectively “Plans”) - to conduct an analysis of its compliance with Parity Rule as required by the relevant provisions of the Plans’ contracts with NH DHHS. Each Plan was required to provide an analysis of the limitations imposed by the Plan for each NH Medicaid behavioral health, substance use disorder, and medical/surgical service provided in the four classification categories (Inpatient, Outpatient, Emergency, and Prescription) in which the Plan provided services in CY 2016. The Plans were also required to provide narrative responses to questions designed to elicit information and assurances that the Plans had processes and procedures in place to ensure parity between BH/SUD services and Med/Surg services for CY 2016. Upon completion of its parity analysis on September 15, 2017, each Plan submitted a certification to NH DHHS attesting that a comprehensive review of its administrative, clinical, and utilization practices for CY 2016 was complete and that the Plan was in compliance with the relevant provisions of the Parity Rule. Based on the compliance certificates submitted by the Plans on September 15, 2017, and the NH DHHS determination that New Hampshire’s CHIP program, the Alternative Benefits Plan (APB) and the 1915c Home and Community Based waivers were in compliance with the relevant provisions of the Parity Rule, NH DHHS determined that the New Hampshire Medicaid Program was in compliance with the Parity Rule. As required by the Parity Rule, NH DHHS submitted its compliance report to CMS on October 2, 2017 (“October 2, 2017 NH DHHS Parity Compliance Report” or “October 2, 2017 Compliance Report”). The NH DHHS October 2, 2017 Parity Compliance Reports includes the following appendices:

  • Appendix A: MCO Contract Parity Requirements – SFY 2018
  • Appendix B: NH DHHS Request for Parity Analysis (July 3, 2017)
  • Appendix C: NH DHHS Request for Parity Analysis: Classification Grid
  • Appendix D: NH DHHS Compliance Monitoring Plan (Final: October 2, 2017).

 

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