“New OIG Report Examines Prior Authorization Denials in Medicaid MCOs”

“New OIG Report Examines Prior Authorization Denials in Medicaid MCOs,” by Heather Saunders and Elizabeth Hinton, Kaiser Family Foundation

“The OIG report underscores concerns about prior authorization and access in Medicaid managed care, keeping this issue at the forefront of ongoing policy discussions. While prior authorizations can help manage health care utilization, denials can create barriers to receiving care, cause delays, affect patient health, and may exacerbate health disparities. OIG suggests that the wide variation in denial rates might be due to varying policies or how they’re carried out. They recommend adding denials and appeals processes that are similar to Medicare Advantage, including stronger state monitoring of denials and a requirement for automatic external medical reviews following MCO appeal denials. In addition to proposed rules to improve access to care in Medicaid managed care, CMS has separately proposed rules around prior authorizations, but these rules mostly focus on streamlining process, reducing approval wait times, and improving transparency.”

LTC Comment, Stephen A. Moses, President, Center for Long-Term Care Reform:

Medicaid pawned off responsibility for providing and managing recipients’ health care to the private sector, but can’t even find time to oversee their work adequately now. Proves the adage “programs for the poor are poor programs” and getting poorer all the time.