Via Health News Illinois

Stakeholders said Thursday that lawmakers need to address prior authorization and other barriers to mental health services, specifically for Medicaid patients.

Dr. Steve Weinstein, medical director at Thresholds, told members of the House’s Mental Health and Addiction Committee that responding to prior authorization requests is “expensive, time consuming and prevents clients or can prevent clients from getting the best medication.”

“Most are diagnosed with a psychotic illness, and it’s quite common for them to also be diagnosed with major depression, bipolar disorder, depression, anxiety disorder and substance use disorders,” he said. “To work towards recovery, our clients often need to take several psychiatric medications.”

While some providers have hired individuals focused specifically on working with insurance companies to receive prior authorization approval, that is a luxury that not all can afford, Weinstein said.

Other providers shared personal stories of patients who wait weeks at a time to receive the medications they have been prescribed due to step therapy and prior authorization processes.

Lily Rocha, associate vice president of policy for NAMI Chicago, said the issue is more pressing as demand for behavioral health services rises in Illinois.

“We know that the needs are more acute and complicated than ever,” she said. “This means that we must remove barriers to mental health treatment and prohibit prior authorization in the outpatient setting, especially in Medicaid.”

Several panelists urged lawmakers to consider legislation filed by Rep. Lindsey LaPointe, D-Chicago, that would ban prior authorization mandates and utilization management controls in Medicaid for psychotropic drugs approved by the Food and Drug Administration and supported by the American Psychiatric Association.

Gov. JB Pritzker unveiled an insurance reform proposal during last month’s State of the State. LaPointe, who serves as chair of the committee, said that any proposal “has to include people on Medicaid or low-income folks all around Illinois who are trying to access basic healthcare and mental healthcare.”

Heather Eagleton, director of legislative affairs for the Department of Healthcare and Family Services, said they have been speaking with advocates on the issue and will continue conversations with lawmakers “on this very important issue.”

LaPointe said Thursday’s hearing builds off two held earlier this year that focused on challenges facing the behavioral healthcare workforce. Among the issues raised during those meetings, she said, was the high administrative burden on providers.

“We are all living through a very significant workforce shortage, and that shortage exists whether you have commercial insurance or Medicaid,” she said.