Mental health providers decry 'mind-numbing' prior authorization burdens as Senate debates reforms

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来源: FierceHealthcare

Mental health providers shared their prior authorization horror stories with senators as the chamber debates a key reform package.

Several mental health providers told a key Senate panel that prior authorization requests are getting in the way of patient care, as the chamber debates a key reform package.

A subcommittee of the Senate Committee on Health, Education, Labor and Pensions (HELP) held a hearing Wednesday on youth mental health. Some of the providers complained of long wait times and high administrative costs for prior authorization, a cost management tool employed by insurers that requires approval before physicians can administer certain services or prescribe drugs.

“It is mind-numbing,” said Ashley Weiss, director of medical student education in psychiatry for Tulane University and one of the panel’s witnesses. “It will take weeks sometimes getting prior authorization for community-based mental health services.”

A particular concern is getting responses for Medicaid mental health claims. Weiss said that in Louisiana there are five companies that provide managed care for Medicaid and each has a different prior authorization system.

“The amount of administrative support you need to get these done is astronomical,” she said.

There does need to be some authorization system in place and a process for helping youths understand the medications that they are prescribed, but the wait for approval of such requests is burdensome, said Sharon Hoover, professor of psychiatry and co-director of the National Center for School Mental Health with the University of Maryland.

“The wait times for getting into mental healthcare … for families can be really impossible to navigate,” she said.

The House did unanimously pass the Improving Seniors Timely Access to Care Act earlier this year, which would require all Medicare Advantage plans to install electronic prior authorization systems to speed up the gap between requests and approvals. It would also set up a system to get faster approvals for items and services that routinely get the green light.

While the legislation passed the House back in September without any opposition, it remains unclear if the Senate will clear it before the end of the year.

Sen. Roger Marshall, R-Kan., endorsed the legislation during the panel hearing, calling prior authorization “the number one physician administrative concern in America.”

Marshall, an obstetrician, said that his nurses sometimes deal with multiple fax requests from insurers as opposed to e-mails. While the legislation only focuses on Medicare, Marshall pledged to “go after [the Children’s Health Insurance Program] and Medicaid” in future packages.

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