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Office of Mental Health

Report on Managed Care Organization Services

The Report on Managed Care Organization (MCO) Services was commissioned by the New York State (NYS) Legislature in Section 1 of Part P of Chapter 57 of the Laws of 2022.

Read the final report: Final Report on Managed Care Organization Services

Key Behavioral Health (BH) findings from the report include but are not limited to:

Noncompliance with MHPAEA:

    The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law designed to ensure fair and adequate access to BH services. NYS issued MCOs 95 citations for noncompliance from 2018 to 2020. A 2022 survey of MCO documents found that several MCOs repeatedly failed to demonstrate compliance. These violations raise further concern about BH access for members.

MCO underspending on BH services:

    Even with insufficient provider networks, MCOs are not spending all their allotted premiums on BH services. A review of two MCO funding mechanisms for BH—the Behavioral Health Expenditure Target (BHET) and Medical Loss Ratio (MLR) recoveries—shows that MCOs remitted over $220 million in allocated premiums back to the state from 2017 to 2020. This includes $91 million in BHET remittances from 2018 to 2020 and $130 million in MLR remittances from 2017 to 2019.

Inappropriate claims denials for BH specialty services:

    The NYS Office of Mental Health (OMH) reviews of BH claims reports submitted by MCOs have found high levels of inappropriate claims denials for BH specialty services. Based on MCO reported claims data from December 2017 to May 2018, OMH estimates there were $39 million worth of claims denials for BH specialty services. OMH investigated the reasons for the inappropriate level of claims denials and issued 20 official citations to certain MCOs.

Please contact OMH Managed Care with any questions, comments, or problems you may be experiencing with this site. If you would like to file a complaint about behavioral health managed care, please visit the Information on Filing a Complaint page. Providers, if you have any questions about the managed care implementation, please complete and send a question form.