A report released May 29 by the Government Accountability Office found a lack of state oversight on Medicaid managed care plans’ use of prior authorization for children’s health care services. It found that none of the states sampled reviewed a representative sample of commercial Medicaid plans’ claim denials or used data to assess “the appropriateness of the full scope of plans’ prior authorization decisions.” The study underscores concerns that Medicaid managed care plans may implement policies that deny medically necessary care to children enrolled in Medicaid.  
 
The GAO recommended the Centers for Medicare & Medicaid Services communicate expectations for how states should monitor the appropriateness of plans’ prior authorization decisions and confirm that states meet these expectations; and clarify whether managed care plans can require prior authorization for early and periodic screening, diagnostic and treatment services when the state doesn't have such requirements. CMS partially concurred with each recommendation, according to the report.

Related News Articles

Headline
The AHA Sept. 24 expressed support for the Medical Student Education Authorization Act (H.R. 5428), legislation introduced in the House Sept. 17 that would…
Headline
The AHA expressed support Sept. 22 to House and Senate sponsors of the Medicare Advantage Prompt Pay Act (H.R. 5454/S. 2879), legislation that would apply a…
Headline
The Senate Sept. 19 failed to adopt a continuing resolution by a 44-48 vote  that would have funded the government through Nov. 21. The CR was passed by…
Headline
A bipartisan House letter by Reps. Dan Crenshaw, R-Texas, Yvette D. Clarke, D-N.Y., Gus M. Bilirakis, R-Fla., and Diana DeGette, D-Colo., urged House…
Headline
The AHA Sept. 15 expressed support for the Ensuring Access to Essential Providers Act, legislation that would require Medicare Advantage plans to cover…
Headline
The AHA detailed its key health care priorities for the remainder of the year in comments to House and Senate majority and minority leaders Sept. 15. The AHA…