News: MA, Medicaid patients face difficult behavioral health access, HHS audit shows

Many Medicare Advantage (MA) and Medicaid managed care plans offer severely limited networks for behavioral health patients, according to a new report released by Department of Health and Human Services (HHS) Office of the Inspector General.

The report analyzed a total of 60 different Medicaid and MA plans across 10 different counties in the United States—five urban and five rural.

According to the report:

• “Almost three-quarters of inactive behavioral health providers (72%) should not have been listed in the network” (p. 2).
• “Almost half of all inactive providers did not work at any of the locations listed in the network directory” (p. 11).
• “About one-fifth of inactive providers did not accept patients with the managed care plan” (p. 11).

“These findings show that additional efforts are needed to ensure that there are enough behavioral health providers in the plans’ provider networks who are available to meet the current needs of enrollees,” the HHS concluded.

The findings, they continued, “further highlight the importance of ensuring that plans provide enrollees with accurate information about their provider networks and that assessments of network adequacy are based on accurate lists of provider networks.”

To this effect, HHS—in its conclusions and recommendations section—suggested: using data to monitor networks/improve the accuracy of MA network directories, further encouraging federal-state initiatives to improve data directory accuracy, and exploring the possibility of a nationwide directory.

Editor’s note: To read the HHS report, click here.