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  • Why We Are Stuck with Prior Authorization Review

    From Drew Altman

    Prior authorization review frustrates patients and physicians, but we likely can’t just eliminate it. In his new column, President and CEO Dr. Drew Altman discusses why, and why the focus is now instead on “doing it smarter.” Altman writes: “A proposal to eliminate prior authorization altogether could be the single most tangible and popular health reform idea a candidate could make. But, in our fragmented health system, with no great way to control costs or limit unnecessary care, we seem to be stuck with prior authorization review…and most payers are now trying to ‘do prior authorization review smarter.’”

  • Prior Authorization in Health Insurance: A Needed Tool to Contain Costs or an Excessive Barrier to Needed Care?

    Event Date:
    Event

    Nearly 1 in 5 consumers with health insurance say their insurer delayed or denied care in the past year due to its requirements for prior authorization, a process through which insurers can require patients to obtain approval in advance before they will agree to cover specific services. On February 22, a panel of four experts joined Larry Levitt, KFF’s executive vice president for health policy, for a 45-minute discussion addressing the future of prior authorization requirements in health care. The panel discussed why insurers use prior authorization, its impact on patients and providers, and how the new regulations may change current practices. They also examined the potential for further regulatory or legislative actions to address ongoing concerns.

  • 10 Things to Know About Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs)

    Issue Brief

    In 2023, 5.2 million dual-eligible individuals were enrolled in a Medicare Advantage plan designed specifically for dual-eligible individuals, known as Dual-Eligible Special Needs Plans (D-SNPs). This brief highlights 10 things to know about D-SNPs, including national and state enrollment trends, plan availability, insurer participation, benefits, and prior authorization rates and denials

  • Proposed Mental Health Parity Rule Signals New Focus on Outcome Data as Tool to Assess Compliance

    Issue Brief

    Proposed updates to federal mental health parity rules would make wide ranging changes to current standards that apply to private insurance and coverage provided by most employers. This issue brief focuses on one aspect of the new proposal---a requirement that plans perform an “outcome analysis” before they can place certain restrictions on behavioral health coverage. This would require that plans evaluate specific data to determine the impact of certain restrictions on behavioral health access, such as prior authorization rules or limited provider network access. The use of data analysis as an oversight tool would be new for federal insurance regulators. The brief discusses this new proposed tool and the key policy questions that it triggers.