OIG Finds South Carolina Failed to Monitor MCO Mental Health Parity Compliance on Prior Authorization
An HHS Office of Inspector General audit found that South Carolina's Medicaid agency did not ensure that three managed care organizations complied with federal mental health and substance use disorder parity requirements for prior authorization processes during the audit period. The state lacked adequate oversight mechanisms to verify that MCOs applied comparable prior authorization criteria and processes for behavioral health services as for medical/surgical benefits. OIG recommended that South Carolina strengthen monitoring protocols and ensure MCOs document parity compliance. The findings highlight enforcement gaps in the Mental Health Parity and Addiction Equity Act as applied to Medicaid managed care.
State Medicaid agencies face heightened federal scrutiny on mental health parity enforcement, with direct compliance and audit risk if MCO oversight protocols cannot demonstrate that prior authorization processes meet MHPAEA standards.
Managed Care · Behavioral Health
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