Behavioral Health and Managed Care
2007-2008 Behavioral Health Prior Authorization Focused Study
The Florida Managed Care External Quality Review (EQR) contract for Fiscal Year 2007-2008 includes a focused study on “Behavioral Health Prior Authorization Processes.” This study focuses on behavioral health outpatient services across Health Maintenance Organizations, Provider Service Networks, and Prepaid Mental Health Plans, collectively referred to as Managed Care Organizations (MCOs).The focused study consists of a desk review aimed at determining how prior authorization processes for outpatient behavioral health services vary across the MCOs. The purpose of the focused study is three-fold:
- To gather preliminary information regarding potential barriers to the prior authorization processes across MCOs;
- To determine to what extent variation exists across the MCOs between prior authorization processes and medical necessity criteria used in prior authorizations; and
- To evaluate how the timeliness of behavioral health prior authorizations varies across MCOs.
The results of this study will provide the Agency for Health Care Administration with information on which to focus quality improvement efforts. These efforts will enhance behavioral health prior authorization processes and foster collaborative efforts between the Agency, managed care organizations, and behavioral health care providers. For more information about this focused study and Florida’s managed care external quality review initiative, please visit http://www. MyFloridaEQRO.com.