Medicare Advantage Prior Authorization Use Common For Higher Levels Of Behavioral Health Services

A federal review of utilization management strategies used by nine Medicare Advantage (MA) organizations to control member access to in-network behavioral health services found that the majority imposed prior authorization and/or internal coverage criteria not used by traditional Medicare to authorize higher levels of care and specialized treatment. None of the MA organizations required prior authorization for lower intensity in-network services such as outpatient counseling and psychotherapy visits. Traditional fee-for-service Medicare does not require prior authorization. ;

The use of prior authorization was reviewed by the Government Accountability Office (GAO), which analyzed information from nine . . .