Kansas Did Not Ensure That Its Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization

Kansas did not ensure that the three Medicaid managed care organizations (MCOs) in the state complied with parity requirements related to prior authorization for MH/SUD services provided to Medicaid enrollees.

None of the three MCOs performed, or provided Kansas with, a complete parity analysis, and Kansas did not request a complete parity analysis from any of the MCOs.

For outpatient out-of-network services, one MCO denied prior authorization requests for MH/SUD services at a higher rate than it denied prior authorization requests for M/S services for the same type of services. Data reliability issues were identified at another MCO.

Kansas did not provide clear guidance regarding parity analyses to the MCOs and did not have policies and procedures in place to provide adequate monitoring of the MCOs; Access to MH/SUD services may have been limited compared to access for M/S services, potentially impacting enrollees’ health and wellness.

Enhance its oversight of the MCOs with respect to parity analyses, accuracy of supporting data, and corrective actions.

Develop and disseminate detailed instructions to the MCOs explaining how to conduct the parity analyses.

Develop and implement policies and procedures to improve its oversight of the MCOs, including formally identifying whether the State agency or KDADS is responsible for oversight of MCOs' compliance with parity requirements and formalizing procedures for the collection and review of the MCOs' submitted supporting data for the parity analyses.