Mental health service utilization review patterns in a Medicaid managed care program.
Am J Manag Care
; 28(2): 81-84, 2022 02.
Article
em En
| MEDLINE
| ID: mdl-35139293
ABSTRACT
OBJECTIVES:
The current study investigated mental health utilization review (UR) clinical service authorization requests, denials, and reasons for denial in a statewide Medicaid managed care organization (MMCO) program. STUDYDESIGN:
Retrospective analysis of utilization review data reported by MMCOs in New York State.METHODS:
Data from the utilization review practices of 15 MMCOs were collected and analyzed for calendar years 2017 and 2018. The data reported are specific to mental health services and include the number of authorization requests, number of clinical denials, and the reasons specified for each denial. Analyses were undertaken to determine the UR denial rates and most common reasons for denials.RESULTS:
A total of 264,901 requests for inpatient mental health service authorizations and 53,687 requests for outpatient mental health service authorizations were made in 2017 and 2018. Of these, 1.5% of inpatient authorization requests and 0.4% of outpatient authorization requests were denied for reasons related to medical necessity. The most common reason for inpatient mental health service denials was that the patient no longer met the standard for the requested level of care.CONCLUSIONS:
Low UR denial rates warrant further examination of the relationship between UR and both quality of care and patient outcomes in mental health care. With the substantial resources spent on UR, findings could point to areas of potential reforms to the system that may minimize these costs and improve care for patients with mental illness.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Medicaid
/
Serviços de Saúde Mental
Tipo de estudo:
Observational_studies
Aspecto:
Implementation_research
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Am J Manag Care
Assunto da revista:
SERVICOS DE SAUDE
Ano de publicação:
2022
Tipo de documento:
Article
País de publicação:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA