Nevada identified insurer violations of mental health laws based on nonquantitative treatment limitations, according to a Dec. 31 report from the state’s insurance division.
To better understand adherence to the Mental Health Parity and Addiction Equity Act, reviewers requested information on comparative analysis reports, medical management guidelines, network adequacy, credentialing, reimbursement and claims ratios, as well as utilization management criteria across prior authorization, concurrent review and retrospective review.
Insurers — with their related Nevada-licensed plans — noted for “areas of concern” or direct violations include UnitedHealthcare, Aetna, Elevance Health, Cigna, Centene, Molina Healthcare, Salt Lake City-based Intermountain’s Select Health, Prominence and Renown Health.
In terms of violations with utilization management, payers denied claims even when prior authorization was not required, mental health and substance use disorders saw more frequent prior authorization use, and there were higher denial rates for these conditions based on “No Prior Auth or Referral.” With respect to network adequacy, there were higher out-of-network denial rates for mental health and substance use disorder and disparities across in- and out-of-network claims. Regulators also observed lower reimbursement and greater fee schedule inconsistencies.
“The overarching issue from a mental health parity perspective is not the amount of income received by the provider, but rather if the provider accepts the lower reimbursement rate and agrees to be a participating provider,” the report said.
The summary also flagged consumer confusion and possible credentialing delays.
Carriers may face fines as a result of the state’s findings. The state could run market conduct examinations or work with the carriers on action plans. The Nevada Division of Insurance submitted a work program request for enforcement funding. The state is encouraging these insurers to reprocess claims and rectify financial issues, as well.
Nevada planned for carrier-specific post-analysis reviews at the start of 2026.
