News: CMS proposes behavioral health services cost-sharing changes

CMS recently issued a proposed rule for 2026, which includes provisions aimed at limiting cost-sharing for Medicare Advantage (MA) behavioral health services to be no greater than traditional Medicare rates, according to JustCoding.

For example, MA plans currently have a 50% coinsurance for opioid treatment program services, but CMS is proposing to change this to zero cost-sharing.

MA plans also currently have 30%-50% coinsurance for mental health specialty services, psychiatric services, partial hospitalization/intensive outpatient services, and outpatient substance abuse services. CMS is proposing to change this to 20%.

The agency is soliciting comments on the potential transition period to implement these new behavioral health cost-sharing standards. Comments for these and other provisions in the proposed rule are due no later than January 27.

Editor’s note: This article first appeared in JustCoding. To read the CMS proposed rule, click here.