Mental Health Parity Improper Practices
As a health plan, we are working with New York State to identify and remediate mental health and substance use disorder improper practices as part of our parity compliance program.
Notice of Improper Practice
Implementing a utilization review policy that uses different standards to determine the level of documentation required for utilization review of mental health or substance use disorder benefits vs. that required for utilization review of medical or surgical conditions, including the submission of medical records, treatment plans, or evidence of patient involvement or motivation in care or patient response to treatment.
Requiring preauthorization, concurrent, or retrospective utilization review for a higher percentage of mental health or substance use disorder benefits in the absence of defined clinical or quality triggers, as compared to medical or surgical benefits.
Implementing a methodology for developing and applying provider reimbursement rates for mental health or substance use disorder benefits that is not comparable to or is applied more stringently than the methodology for medical or surgical benefits.
Implementing claim edits or system configurations that provide for higher rates of approval through auto-adjudication for claims for inpatient medical or surgical benefits than for inpatient mental health or substance use disorder benefits.