States Lack Consistent Oversight Of Medicaid MCO Prior Authorization Requirements For Benefits Under EPSDT

States lack consistent oversight of Medicaid managed care organization (MCO) use of prior authorization for services to children provided under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. EPSDT entitles child beneficiaries to a comprehensive set of screening, diagnostic, and treatment services, some of which are subject to prior authorization. A review of state and MCO policies in the District of Columbia, Florida, Massachusetts, Missouri, and Utah found that states have not consistently reviewed the MCO prior authorization decisions for EPSDT services. Further, the Centers for Medicare & Medicaid Services (CMS) has not clearly defined whether health plans . . .