Are pre-authorization requirements an access barrier to outpatient mental health care for medicaid enrollees? A survey of providers.

BACKGROUND Pre-authorization requirements permit managed care organizations control over access to care. Anecdotal reports to the Wisconsin Medicaid program suggest that pre-authorization requirements are so onerous that they are barriers to outpatient mental health care. METHODS Clinicians providing mental health/alcohol and other drug abuse services to Wisconsin Medicaid were surveyed regarding their experiences obtaining outpatient service pre-authorizations from health maintenance organizations (HMO) for Medicaid enrollees. The survey obtained factual information regarding pre-authorization procedures and decisions, as well as clinicians' attitudes about the pre-authorization process. RESULTS Requests for service pre-authorizations are generally responded to in a timely fashion and frequently approved. One hundred fifty seven (44%) respondents rated the HMO that they worked with as above average or the best while 97 (27%) rated it as below average or the poorest. Respondents' criticisms of their HMO focused on failures to make useful treatment suggestions and a lack of understanding regarding the limited availability of community resources that could be alternatives to treatment. Therapist attitude was more favorable when pre-authorization was sought from the HMO directly rather than through a gatekeeper. CONCLUSION The pre-authorization requirement for outpatient services is not an undue burden for the mental health/alcohol and other drug abuse providers or patients.