Attention NYS Council Members Serving Children

March 2, 2020

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