MassHealth Seeks to Expand Prior Authorizations

A new MassHealth policy that would require prior authorizations for more than 350 medical and diagnostic services is on hold for now as the state gathers feedback from those affected by the new rules. The procedures that are being considered include obstetric and non-obstetric ultrasounds, advanced imaging, radiation therapy, polysomnography, cardiology, and joint arthroscopy. 
Hospitals have many questions with the proposal and are concerned with the inclusion of ultrasounds, and especially obstetrical ultrasounds, in the list of procedures requiring prior authorization. MHA and others are now working with MassHealth to better understand the proposed policy and to incorporate provider feedback in any final version. A separate process is also underway to inform an additional proposed MassHealth prior authorization requirement for more than 200 specific drugs administered in hospital outpatient departments.
“We’re pleased that MassHealth is now engaging with providers and is considering our concerns and questions. New prior authorization requirements will undoubtedly increase administrative expenses and burdens of providers, and there are patient access concerns as well. In an environment where hospitals and providers are being held accountable for utilization, including through the MassHealth Accountable Care Organization program, the cost and value of these additional administrative processes should be considered carefully,” said MHA’s Senior Director of State Government Finance and Policy Dan McHale. 
Administrative costs have been a topic of discussion at the recent Health Policy Commission cost trend hearings. In its 2018 health cost trends report, the HPC stated that “the commonwealth should take action to identify and address areas of administrative complexity that add costs to the healthcare system without improving the value or accessibility of care.