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

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.

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.