New Federal Rule Aims To Expand Access To Behavioral Health Care, Nevada Health Link

By Camalot Todd, Nevada Current

April 18, 2023

The Centers for Medicare & Medicaid Services announced Tuesday the 2024 Notice of Benefit and Payment Parameters Final Rule, a new federal policy that will expand access to behavioral health services and health care coverage by changing special enrollment period qualifications on the public marketplace in 2024.

More Americans and Nevadans are getting access to health care through the public marketplace. The state saw an increase in enrollment in its public marketplace, Nevada Health Link which is overseen by Silver State Health Insurance Exchange, over the last three years, in part due to expanded federal and state subsidies.

Beginning January 1, 2024, people losing Medicaid or Children’s Health Insurance Program (CHIP) coverage will be allowed 90 days to select a plan during a special enrollment period. The 2024 date coincides with the end of COVID-19 rules that require states to provide continuous enrollment in exchange for federal funding. The 90-day rule aligns with the period that people who have lost Medicaid or CHIP coverage have for the state to reconsider enrolling them again.

The rule creates two new essential community provider categories critical to delivering needed behavioral health care: Substance Use Disorder Treatment Centers and Mental Health Facilities. Essential community provider categories are health care providers that serve high-risk, special needs and underserved individuals. Every county in Nevada qualifies as a federally designated behavioral health care provider desert.

The rule expands access by requiring plans on the marketplace to contract with at least 35% of available essential community providers in the service area for family planning providers and federally qualified health centers, such as Silver State Health Services in Pahrump or North Las Vegas Family Health in North Las Vegas. Federally qualified health centers provide mental and behavioral health care, dental care, primary care and more to vulnerable and medically underserved populations.

Additionally, plans on the marketplace must include at least 35% of providers in any given market in their networks. Despite the need in Nevada for behavioral health care and the shortage of providers, many providers are denied entry to be in insurance networks.

The new rules are designed to increase provider choice and expand access to care for people who are low-income, live in underserved areas, or have complex or chronic conditions, which are impacted more by higher costs when forced to get out-of-network care.

“Today’s announcement of the 2024 Notice of Benefit and Payment Parameters Final Rule is a step forward toward creating a health care system which prioritizes equity, access, and affordability,” said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra in a press release. “HHS remains committed to removing barriers to care to ensure quality health care is within reach for everyone who needs it.”

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