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Series: States' and MCOs' Compliance With Mental Health Parity Requirements

Announced on  | Last Modified on  | Series Number: W-00-24-31565
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) promotes equal access to treatment for mental health and substance use disorder (MH/SUD) by prohibiting coverage limitations that apply more restrictively to MH/SUD benefits than medical or surgical benefits. Such limitations could include higher copayments, separate deductibles, and stricter preauthorization or medical necessity reviews, as compared to other covered medical treatments. Federal regulations require managed care organizations (MCOs) with plans that provide services to Medicaid enrollees to comply with the parity provisions of MHPAEA. Federal regulations require that States or their MCOs, as applicable, conduct analyses to demonstrate compliance with parity requirements. CMS reviews States' parity analyses as part of its review of States' MCO contracts. We will audit CMS's oversight of States' compliance with Federal parity requirements, including whether States and their MCOs conducted the required parity analyses and whether States ensured that their MCOs complied with certain parity requirements for MH/SUD benefits.

There are 4 projects in this series.

Project titles will remain unpublished until projects are complete and reports are posted.

ACTIVE PROJECTS IN THIS SERIES (3)

Project A-07-24-02842 • Announced on Nov 30, 2023

Project A-02-24-01011 • Announced on May 16, 2024

Project A-04-24-07115 • Announced on May 28, 2024

COMPLETED PROJECTS IN THIS SERIES (1)

Mental Health Parity Oversight

Project A-02-22-01016 • Completed on March 25, 2024

TIMELINE

  • June 21, 2022
    Series Number W-00-24-31565 Assigned
  • June 21, 2022
    Project Announced

    Mental Health Parity Oversight - A-02-22-01016

  • November 30, 2023
    Project Announced

    Project A-07-24-02842

  • March 25, 2024
    Project Complete - A-02-22-01016

    Mental Health Parity Oversight has been marked as complete. This audit resulted in 8 recommendations.

  • May 16, 2024
    Project Announced

    Project A-02-24-01011

  • May 28, 2024
    Project Announced

    Project A-04-24-07115

  • Today
    3 Audits In-Progress
  • Est FY2026
    Estimated Fiscal Year for Series Completion

1 REPORT PUBLISHED

CMS Did Not Ensure That Selected States Complied With Medicaid Managed Care Mental Health and Substance Use Disorder Parity Requirements (A-02-22-01016)

24-A-02-050.01 to CMS - Closed Implemented
Closed on 09/16/2025
We recommend that the Centers for Medicare & Medicaid Services improve its oversight of States' compliance with MH/SUD parity requirements, including strengthening its followup procedures, including regular communication with States, to verify that States perform parity analyses across their MH/SUD delivery systems.

24-A-02-050.02 to CMS - Closed Implemented
Closed on 09/13/2024
We recommend that the Centers for Medicare & Medicaid Services improve its oversight of States' compliance with MH/SUD parity requirements, including requiring States in which MCOs are responsible for the parity analysis to submit information MCOs provided regarding compliance with parity requirements to CMS for its review as part of the contract approval process and, if necessary, seeking additional regulatory authority to do so.

24-A-02-050.03 to CMS - Closed Implemented
Closed on 09/16/2025
We recommend that the Centers for Medicare & Medicaid Services improve its oversight of States' compliance with MH/SUD parity requirements, including following up with any States that have identified any noncompliance with parity requirements to verify that the States have taken actions to address the noncompliance.

24-A-02-050.04 to CMS - Open Unimplemented
Update expected on 03/16/2026
We recommend that the Centers for Medicare & Medicaid Services improve its oversight of States' compliance with MH/SUD parity requirements, including maintaining documentation of its communications with States related to compliance with MH/SUD parity requirements and actions taken to correct any identified deficiencies.

24-A-02-050.05 to CMS - Closed Implemented
Closed on 09/13/2024
We recommend that the Centers for Medicare & Medicaid Services require States to improve their monitoring of MCOs' ongoing compliance with MH/SUD parity requirements by modifying State policies and procedures for reviewing MCOs' compliance with contract provisions to include written procedures for reviewing compliance with MH/SUD parity requirements.

24-A-02-050.06 to CMS - Closed Implemented
Closed on 09/13/2024
We recommend that the Centers for Medicare & Medicaid Services require States to improve their monitoring of MCOs' ongoing compliance with MH/SUD parity requirements by requiring MCOs to update parity analyses when benefits change or deficiencies are corrected.

24-A-02-050.07 to CMS - Closed Implemented
Closed on 09/13/2024
We recommend that the Centers for Medicare & Medicaid Services require States to improve their monitoring of MCOs' ongoing compliance with MH/SUD parity requirements by requiring newly added MCOs to conduct parity analyses.

24-A-02-050.08 to CMS - Closed Implemented
Closed on 09/13/2024
We recommend that the Centers for Medicare & Medicaid Services require States to improve their monitoring of MCOs' ongoing compliance with MH/SUD parity requirements by conducting followup in a timely manner with MCOs that have identified noncompliance with parity requirements to verify that the MCOs take corrective actions to address the noncompliance.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Hospitals Managed Care Mental Health Substance Abuse Disorder
Target Groups
-
Financial Groups
Medicaid