OPEN MINDS reports that two selected Arizona Medicaid plans did not complete annual analyses of prior authorization rules for behavioral health services in fiscal 2022-2023.
Audit review of Arizona Medicaid plans
OPEN MINDS reports that auditors reviewed three Arizona Medicaid managed care organizations selected for an audit by the U.S. Department of Health and Human Services Office of Inspector General. According to OPEN MINDS, the audit examined whether the selected organizations completed required annual analyses during the 2022-2023 federal fiscal year.
OPEN MINDS states that two of the three selected Arizona Medicaid managed care organizations did not complete the required annual analyses. The analyses were intended to demonstrate that prior authorization requirements for mental health and substance use disorder services were no more restrictive than requirements for medical and surgical services, according to OPEN MINDS.
Prior authorization parity requirements
According to OPEN MINDS, the audit concerned federal mental health and substance use disorder parity requirements related to prior authorization. OPEN MINDS reports that the required analyses were annual reviews of the organizations’ prior authorization requirements across behavioral health and medical or surgical services.
OPEN MINDS says the auditors found that the Arizona Health Care Cost Containment System could not demonstrate that the two managed care organizations complied with the applicable federal parity requirements related to prior authorization. The source does not state that the audit reviewed every Arizona Medicaid managed care organization.
What the finding does and does not address
OPEN MINDS attributes the finding to auditors conducting the Department of Health and Human Services Office of Inspector General audit. The reported finding concerns whether the selected managed care organizations completed analyses required to show that behavioral health prior authorization requirements were not more restrictive than medical and surgical requirements.
OPEN MINDS does not describe any change to Arizona Medicaid coverage rules, prior authorization rules, or plan operations following the audit finding. The source also does not identify the two managed care organizations referenced in the auditors’ finding.
What this means for Arizona patients
For people looking for treatment locally, the finding reported by OPEN MINDS concerns Arizona Medicaid plan analyses of prior authorization parity requirements for behavioral health services. The directory lists 196 published clinics in Arizona, which may help people identify local treatment options while they review coverage and authorization details with their health plan.
This is general information, not medical advice.
More Arizona reporting on access & coverage.
This report is educational and is not medical advice. Coverage, availability and eligibility can change; verify details with the named source or your care team.