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News & Press: Legislative Updates

WSHA Ad-Hoc Committee on Medicaid Prior Authorization

Monday, June 20, 2016  
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Insurance reimbursement and containing associated costs require ongoing attention from the WSHA membership and these concerns lead to the initiation of the WSHA Ad-Hoc Committee on Medicaid Prior Authorization in 2014.  This committee has continued to be active during the past year.  Activities during the past year have included:

  • Conference calls every 4-8 weeks

  • Active collaborations with Wisconsin Occupational Therapy Association (WOTA) and Wisconsin Physical Therapy Association (WPTA) associations and consumer groups, including Disability Rights Wisconsin (DRW).  This included participation in WSHA and Therapy Coalition meetings with the Department of Health Services (DHS) and legislators, as well as presenting testimony as a part of a public hearing on the Medicaid PA process conducted by the Assembly Committee on Health.

  • Coalition efforts included requesting, receiving and analyzing information related to PAs provided by DHS.  WSHA analysis of the data provided by DHS highlighted the severity of the PA issues for SLPs, reflecting that for the time frame they reported, approximately one in five SLP PAs were denied, a denial rate approximately two to three times higher than that reported for OT and PT PAs.   

  • Completed activities associated with an ASHA reimbursement grant, including implementing an online survey for providers and consumers regarding the PA process.  Survey results highlighted concerns that included the extensive time associated with completing PAs, the high rate of PA returns that commonly request information already provided, and significant barriers for consumers to access essential care.

  • In conjunction with the Therapy Coalition and consumer groups, responded to a request from members of the Assembly Committee on Health for recommendations for legislative changes to the PA process.  Proposed changes included reforming the PA appeals process, broadening referral source options (e.g., to include Physician’s assistants), eliminating PA requirements for initial evaluations associated with a new episode of care, establishing an advisory committee related to therapy PAs, comprised of therapy and consumer groups, and establishing revised processes for consumers that have severe and chronic conditions that have made them eligible for MA due to disability.

  • WSHA contributed to the successful efforts to get MA prior authorization department moved from the Office of the Inspector General (OIG) back to DHS.  The WSHA committee will continue to collaborate with therapy and consumer coalitions to resolve concerns with the PA process, considering solutions that include seeking legislative changes that are currently under consideration as well as enhancing collaborations with DHS that are anticipated to be enhanced with the prior authorization unit moving from OIG back to DHS.

 


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