title: Are pre-authorization requirements an access barrier to outpatient mental health care for medicaid enrollees? A survey of providers.
abstract: 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.
  
  
  CONCLUSIONS
  The pre-authorization requirement for outpatient services is not an undue burden for the mental health/alcohol and other drug abuse providers or patients.
authors.affiliation: APS Healthcare, Madison, Wisconsin, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Kinderman
authors.forename: Bruce
authors.initials: B
authors.lastname: Christiansen
authors.forename: Richard
authors.initials: R
authors.lastname: Carr
mesh_terms: D006297:Health Services Accessibility; D006801:Humans; D007345:Insurance Claim Review; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid; D008605:Mental Health Services / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014922:Wisconsin