Friday, June 26, 2009

Blue Cross to require Florida psychiatrists to get prior authorization before treating patients

From The Naples News:

NAPLES, Fla. — Mental-health advocates are taking issue with Blue Cross and Blue Shield of Florida for a new rule taking effect in fall requiring psychiatrists to get prior authorization before treating patients in their offices or other outpatient setting.

Letters were sent out from Blue Cross to psychiatrists and other mental-health providers recently outlining the prior authorization rule, effective Oct. 3. The mental-health professionals who accept Blue Cross insurance must sign a contract amendment by a June 24 deadline.

They must get prior authorization for treating patients for office-based care, inpatient admissions, and for partial psychiatric and substance abuse treatment, according to the Blue Cross notice. Emergency visits are covered but the provider must request authorization.

For established patients, the treatment plan must be submitted and approved as of Oct. 3, and prior authorization must be obtained before seeing a new patient. A treatment plan must be sent in before the ninth visit with the new patients.

The rule is a setback for people with mental illnesses, said Kathryn Leib-Hunter, executive director of the National Alliance on Mental Illness of Collier County.

“It simply means access to care is even more hindered by this new policy,” she said. “Chances are, more emergencies are going to occur that could have been prevented. People will wind up in the (crisis stabilization unit) and (hospital) more so now.”

Blue Cross has the state insurance contract and one in four state employees need mental-heath care, Leib-Hunter said.

What especially bothers her is that Blue Cross officials say the new rule is necessary because of the federal Mental Health Parity Act of 2008 that is intended to end inequity between mental health treatment and medical treatment for plans with 50 or more employees.

A Blue Cross spokesman said the company needs to examine reducing costs because the federal mental health parity law could mean increased costs.

“It is our obligation to our members that we continually monitor the necessity of medical and mental procedures and accompanying costs, and look at identifying ways to reduce excess costs if warranted,” Paul Kluding, said in written statements. “With the potential increase in mental health benefits, this authorization allows us to examine cognitive treatment being given to our members and to re-affirm that our members are receiving the proper mental-health care.”

Marcia Mathes, president of the board of the National Alliance on Mental Illness Florida, said the state chapter doesn’t have any legal standing to halt Blue Cross but it will register complaints with the governor’s office, the state Department of Financial Services and anybody else concerned about the implications of insurer’s intentions.

“It’s pure stigma,” Mathes said. “The whole point of parity is to erase some of the stigma attached to (mental illness). It places an incredible burden on psychiatrists, most of whom are solo practitioners. They don’t have a huge staff.”

She’s heard that the Florida Psychiatric Association is also concerned that psychiatrists will decide to drop Blue Cross.

Kluding, the Blue Cross spokesman, said doctors dropping Blue Cross would be unfortunate. Prior authorization is already necessary for HMO’s for federal employers, he said.

“In fact, the required treatment plan is a short questionnaire completed by the office staff in most cases,” he said. “It only takes a few minutes and contains information that most likely already exists in the patients’ files, such as treatment goals.”

Mathes said the National Alliance on Mental Illness has been active in 37 states that have passed state mental-health parity laws. There’s been no huge increase in costs to the insurer — the average is usually 1 to 3 percent — but employee absenteeism goes down and productivity goes up with access to mental-health treatment, she said.
Dr. Jeffrey Fabacher, a psychiatrist in private practice in Naples, said he wasn’t surprised but disappointed by Blue Cross’ action.

“The whole point of parity is to stop the discrimination because mental illness is no different than medical illness, but clearly they are going to make it more complicated to access care,” Fabacher said.

The insurance industry fought the mental health parity bill but studies showed the cost increase would be around one or two percent and no surge in enrollees seeking treatment, he said.

Some psychiatrists and other providers may drop Blue Cross which will further exacerbate access issues, Fabacher said. He declined to say what he plans to do.

A bigger concern is that the insurer wants to reduce payments to physician assistants and others who work directly under psychiatrists, he said.

The David Lawrence Center, a private nonprofit mental health center in Golden Gate, anticipates administrative expenses rising and likely having to hire more staff to handle the prior authorizations for outpatient programs, said Sharie Boscaglia, clinical records and support services director.

About 12 percent of all of the center’s active patients have some Blue Cross coverage.
Another concern is how Blue Cross defines what an emergency visit is because many of the center’s patients are walk-ins with urgent issues that need immediate attention, she said.

Patients themselves won’t face an increase in their fees and the center won’t turn anyone away because they have Blue Cross, she said.

“This doesn’t have an impact on fees,” she said. “It comes back to the organization to get the authorization.”