The Centers for Medicare and Medicaid have fallen short in ensuring several states comply with Medicaid managed care mental health and substance use disorder parity requirements.
That’s according to a new audit by the Office of Inspector General (OIG), which evaluated eight states with Medicaid managed care contracts. Four of the states in the review, including Arizona, New Jersey, New York and Texas, were required to conduct a parity analysis themselves. In the other four states, Illinois, Kansas, Mississippi and South Carolina, managed care organizations (MCOs) were required to perform a parity review.
Mental health parity, which requires health plans to cover behavioral health on par with physical health care, has been the law since the Mental Health Parity and Addiction Equity Act (MHPAEA) passed in 2008. Still, the rollout of parity has often been flawed.
None of the eight states in the audit contained the required parity provisions by the compliance date set by the federal government.
Specifically, the report found that not a single one of the four states required to conduct their own parity analysis did so or made the documentation publicly available by the initial compliance date set by the federal government. However, the states in question eventually conducted their own analysis.
In the four states where MCOs were required to do parity analysis, three conducted the review by the compliance date, and the fourth requested an extension.
Still, none of the eight states made the documentation publicly available by the compliance date set.
“We recommend that CMS improve its oversight of states’ compliance with mental health and substance use disorder parity requirements and require states to improve their monitoring
of MCOs’ ongoing compliance with mental health and SUD parity requirements,” the OIG wrote in the report.
The OIG spelled out several recommendations for CMS to address the parity issues.
Specifically, the OIG recommends CMS verify that states perform the required analysis. This includes bolstering following procedures and improving communication with states to make sure they are performing the analysis, and following up with states that are identified as noncompliant.
The agency also recommends that CMS require states to improve their monitoring of MCOs’ behavioral health parity requirements. This could mean modifying state policies and procedures for reviewing MCOs’ compliance and requiring MCOs to update their parity analysis when benefits are changed or deficiencies are corrected.
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