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21 - 30 of 39 Results

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

Event Date: Feb 22, 2024

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

Feb 9, 2024

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

Sep 29, 2023

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…
Consumer Problems with Prior Authorization: Evidence from KFF Survey

Sep 29, 2023

Issue Brief

This Data Note highlights findings from the KFF Consumer Survey on problems consumers have experienced with prior authorization requirements. Overall, those with Medicaid, those who are higher utilizers of care, and those who seek certain types of care such as care for a mental health condition or diabetes encountered more problems with prior authorization over the past year.
New OIG Report Examines Prior Authorization Denials in Medicaid MCOs

Jul 27, 2023

Policy Watch

Congress asked the U.S Department of Health and Human Services (HHS) Office of the Inspector General (OIG) to investigate whether Medicaid MCOs are providing medically necessary health care services to their enrollees. OIG found that Medicaid MCOs had an overall prior authorization denial rate of 12.5%–more than 2 times higher than the Medicare Advantage rate. Prior authorization denial rates ranged widely across and within parent firms and states. After a prior authorization request is denied,…
Testimony: Prior Authorization in Medicare Advantage

May 17, 2023

Issue Brief

Jeannie Fuglesten Biniek, an Associate Director for the Program on Medicare Policy at KFF, testified before the Senate Homeland Security and Government Affairs Committee Permanent Subcommittee on Investigations on May 17, 2023 as part of a hearing on Examining Health Care Denials and Delays in Medicare Advantage.
Mental Health and Substance Use Disorder Coverage in Medicare Advantage Plans

Apr 28, 2023

Issue Brief

This brief describes the scope of mental health and substance use disorder benefits in Medicare Advantage plans, including extra benefits, cost sharing, and prior authorization and referral requirements, based on an analysis of the Centers for Medicare and Medicaid Services (CMS) Medicare Advantage plan benefit and enrollment files for 2022.
Medicaid Behavioral Health Services: Naloxone Nasal Spray Covered Without Prior Authorization

Mar 16, 2023

State Health Facts Indicator
Medicaid Behavioral Health Services: Naloxone Nasal Spray Atomizer Covered Without Prior Authorization

Mar 16, 2023

State Health Facts Indicator
Medicaid Behavioral Health Services: Naloxone Available in at Least One Formulation Without Prior Authorization

Mar 16, 2023

State Health Facts Indicator

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