Mismanagement of Tax Dollars - Provider Medicaid Reimbursements

Excessive mental health denials for treatment from insurance companies prevents early intervention and continuum of care.

PLANO, Texas - Txylo -- Elevate Healthcare is a behavioral health provider assisting with de-escalating behavioral health crises.  Our services avoid costly emergency department visits and hospitalizations and may also prevent the arrest and incarceration of people with behavioral health conditions, who are disproportionately represented in the nation's jails and prisons and among fatal police shootings. To encourage legislature to audit insurance companies authorization process - End utilization management practices that hinder Medicaid beneficiaries' access to evidence-based services, the American Rescue Plan Act provides an 85 percent enhanced federal matching rate for three years and $15 million in planning grants to states that opt to cover them.

Unnecessarily restrictive policies that prevent or delay receipt of services can undermine coverage of evidence-based services. Mental health providers are increasingly raising concerns that some utilization management practices, such as excessive prior authorization requirements for outpatient services, prevent or delay access to stabilization and potentially lifesaving mental health care.  State and federal policymakers — including CMS — should assess current utilization management strategies to determine whether policies create barriers to care.

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Federal law requires insurers to design plans that treat mental illness similarly to physical conditions such as diabetes. These fairly new regulations stop companies from gouging people financially for behavioral care that they need, But there's a loophole that these insurance companies have been using — especially now, during times when money is tight for them — that is making it much more challenging for people to get affordable mental health treatment. Here's a little more on that aforementioned loophole in the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008: That act mandates that insurance companies cover mental health.

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Margie Barilla

Source: Elevate Healthcare

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