GAO says CMS should target behavioral health services in prior authorization audits

The Government Accountability Office May 29 released a report recommending the Centers for Medicare & Medicaid Services target behavioral health services when auditing Medicare Advantage plans’ use of prior authorization. CMS said it currently does not target behavioral health services because they make up a small percentage of MA services, the report said.
The report describes selected MA organizations’ prior authorization requirements and use of internal coverage criteria for prior authorization decisions on behavioral health services. It also examines CMS’ oversight of the use of internal coverage criteria, among other issues. GAO said that CMS “would take the recommendation under advisement in the future.”
Related News Articles
Headline
As the American population ages, the behavioral health care needs of older adults are becoming an area of vital focus. A new AHA webpage on older adult…
Headline
A report released June 17 by NORC at the University of Chicago, commissioned by the Coalition to Strengthen America’s Healthcare, found that patients enrolled…
Headline
The Centers for Medicare and Medicaid Services May 30 released a notice requesting comments on a proposed Medicare Advantage service level data collection…
Headline
The Centers for Disease Control and Prevention yesterday released its National Violent Death Reporting System report on violent deaths in 2022, finding that…
Headline
A study published May 27 by JAMA Internal Medicine found declines in self-reported maternal mental health from 2016 to 2023. Researchers used the National…
Headline
The House June 4 passed the AHA-supported SUPPORT Act (H.R. 2483) by a 366-57 vote. The legislation reauthorizes key prevention, treatment and recovery…