Medicaid Managed Care & Parity Regulations Resource Page
On May 6, 2016, the Centers for Medicare & Medicaid Services (CMS) published the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Final Rule (commonly referred to as the “Mega Regs” or “Mega Rule”). The new federal regulations modernize the rules governing the Medicaid program and are set to be implemented over the next several years. County mental health plans and counties that opt-in to the Drug Medi-Cal Organized Delivery System waiver are subject to the new Medicaid managed care regulations in 42 CFR Part 438.
Another significant regulatory change to 42 CFR Part 438 in 2016 was the publication of final parity regulations for the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which has an implementation date of October 2, 2017. All county behavioral systems are subject to the new parity regulations in 42 CFR Part 438 Subpart K.
This page is intended to provide resources to county behavioral health departments that will assist them with understanding the requirements of the new federal regulations.
Please contact Linnea Koopmans at lkoopmans@cbhda.org with any questions or concerns.
CBHDA Resources
Fact Sheets
- Network Adequacy Fact Sheet
- Grievance and Appeals System Fact Sheet
- Beneficiary Informing & Authorization Fact Sheet
Implementation Dates
- CMS Medicaid Managed Care Final Rule, MHP Sections of Impact by Category and Implementation Date, May 2017 (June 9, 2017)
Comments and Presentations
- Final Rule Implementation Presentation (PDF) (August 7, 2017)
- Webinar (Link)
- DHCS Priorities for Final Rule Implementation (August 2017)
- CBHDA Medicaid Managed Care Final Rule, Provisions Effective July 1, 2017 (June 16, 2017)
- CBHDA Comments on DHCS Network Adequacy Policy Proposal
- An Overview of the CMS Medicaid Managed Care Final Rule for County Behavioral Health Directors, December 14, 2016
DHCS Resources
- DHCS Medicaid Managed Care Final Rule: Network Adequacy Standards (July 19, 2017)
- DHCS Mega Regs. Boot Camp, April 2017
- CalQIC 2017 Medicaid Managed Care Rule Presentation, March 2017
- DHCS Network Adequacy Policy Proposal, February 2017
- DHCS Stakeholder Advisory Committee Presentation on Network Adequacy Proposal, February 2017
- Medicaid Managed Care Regulations MHP Contract Revisions and Parity Rule Webinar, January 2017
- DHCS Presentation to CBHDA Medi-Cal Policy Committee, August 2016
Source Documents
- Federal Medicaid and CHIP Managed Care Regulations (CMS-2390-F)
- Federal Parity Regulations (CMS-2333-F)
- MHP Contract Boilerplate
Federal Resources
- CMS Overview of Managed Care Rule
- CMS Medicaid and CHIP Managed Care Final Rule Website (Fact Sheets and Presentations)
- CMS Overview of Medicaid Parity Rule
- CMS Behavioral Health Services Website (MHPAEA Regulations Fact Sheets, Toolkit, and Presentations)
- Managed Care Rule Implementation Dates