Rep. Marvin Lim Seeks Answers on Mental Health Parity and DCH Oversight of Medicaid CMOs

ATLANTA - State Representative Marvin Lim (D-Norcross) recently sent a letter to the Georgia Department of Community Health (DCH) asking the agency to explain certain mental health parity reports submitted by Amerigroup, Caresource and Peach State Health Plan. Rep. Lim emphasizes that the reports raise questions for him about whether the Care Management Organizations (CMOs) correctly identified the medical-necessity standards they use and whether DCH independently verified compliance before publicly reporting that the plans had identified no violations.

"DCH has told the public that no parity violations were identified, but the reports themselves leave important questions unanswered," said Rep. Lim. "This is not about what additional authority we might wish DCH had. It is about whether DCH has fully and correctly exercised the authority it already has. If there is information outside the public reports that resolves these concerns, DCH should show us what it reviewed and how it reached its conclusions. Georgia's mental health parity law originated in the House, and ensuring that it is actually being followed-and, more broadly, that CMOs are properly regulated-is particularly important to me as a member of the House Health Committee."

Rep. Lim's adds that he also has concerns over a governing definition missing from Amerigroup's report, a medical-necessity definition referenced but not disclosed by CareSource, as well as language used by Peach State Health Plan that he believes may differ from Georgia's statutory standard.

"The questions also go beyond mental health parity," added Rep. Lim. "They bear on the larger issue of whether DCH is fully and properly exercising the authority it already has over CMOs-an issue that has taken on added importance amid highly publicized concerns about recent CMO rate reductions."

In his letter, Rep. Lim requests that DCH identify the medical-necessity standards it determined govern each CMO, explain how it addressed the CareSource and Peach State issues, describe the independent review it conducted and provide the records supporting its conclusions. He is also asking DCH to determine whether any reports or public summaries need to be corrected and whether affected member decisions warrant retrospective review.

The full text of Rep. Lim's letter to DCH may be found here.

Representative Marvin Lim represents the citizens of District 98, which includes a portion of Gwinnett County. He was first elected to the House of Representatives in 2020 and currently serves on the Agriculture & Consumer Affairs, Appropriations, Appropriations Subcommittee on Public Safety, Health and Retirement committees.

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