New York Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization
Learn how the AI-generated research projects were createdOverall Conclusion
New York did not ensure that all three selected Medicaid managed care organizations complied with MH/SUD parity requirements related to prior authorization.
Source Document
Audit Scope
New York State Medicaid managed care organizations; three selected MCOs; calendar year 2023; assessment of parity requirements related to prior authorization for MH/SUD services.
Key Findings Summary
Analyses comparing denial rates for mental health and substance use disorder (MH/SUD) services to medical/surgical (M/S) services in the same benefit classification were not sufficiently supported and did not clearly indicate comparability, potentially indicating noncompliance with parity requirements.
The denial rates for MH/SUD services exceeded New York’s established threshold.
The selected MCOs continued to be noncompliant with MH/SUD parity requirements related to prior authorization more than six years after the October 2017 compliance deadline.
AI-Assisted
AI Scope Summary
This audit assessed whether New York's Medicaid managed care organizations complied with mental health and substance use disorder parity requirements for prior authorization in calendar year 2023, found noncompliance despite a parity program, and recommended stronger monitoring and corrective actions to improve compliance.
AI-Generated Insight
The audit highlights persistent parity compliance gaps in New York’s Medicaid MH/SUD prior authorization practices, despite a parity program, and recommends stronger monitoring and corrective actions to drive consistent compliance across MCOs.
Audit Objectives
Determine whether New York ensured that three selected Medicaid managed care organizations complied with parity requirements related to prior authorization for mental health and substance use disorder services provided to Medicaid enrollees during calendar year 2023.
Audit Findings (3)
Analyses comparing denial rates for mental health and substance use disorder (MH/SUD) services to medical/surgical (M/S) services in the same benefit classification were not sufficiently supported and did not clearly indicate comparability, potentially indicating noncompliance with parity requirements.
The denial rates for MH/SUD services exceeded New York’s established threshold.
The selected MCOs continued to be noncompliant with MH/SUD parity requirements related to prior authorization more than six years after the October 2017 compliance deadline.
Recommendations (2)
Improve policies and procedures for monitoring MCOs' ongoing compliance with parity requirements related to prior authorization of MH/SUD services, including collecting and reviewing supporting data from MCOs for their comparative analyses; providing clear, uniform guidance to MCOs on maintaining accurate data to support analyses; and establishing a formal written policy that includes its denial rate threshold and actions when denial rates exceed the threshold.
Continue to utilize available corrective action measures, such as sanctions, to address instances where MCOs do not consistently meet parity requirements related to prior authorization.