Wisconsin Medicaid Reimburses Selected Services Provided Through Telemedicine
Effective for dates of service on and after July 1, 2006, Wisconsin Medicaid will cover certain services delivered via telemedicine (also known as "Telehealth"). Providers at remote locations receive the same reimbursement as they would for face-to-face contacts. The originating site where the recipient is located may be reimbursed a facility fee.
Are
Pre-Authorization Requirements an Access Barrier to Outpatient Mental
Health Care for Medicaid Enrollees? A Survey of Providers
Background: Pre-authorization requirements permit managed care organizations control over access to care. Anecdotal reports to the Wisconsin Medicaid program suggest that pre-authorization requirements are so onerous that they are barriers to outpatient mental health care. Methods: Clinicians providing mental health/alcohol and other drug abuse services to Wisconsin Medicaid were surveyed regarding their experiences obtaining outpatient service pre-authorizations from health maintenance organizations (HMO) for Medicaid enrollees. The survey obtained factual information regarding pre-authorization procedures and decisions, as well as clinicians' attitudes about the pre-authorization process. Results: Requests for service pre-authorizations are generally responded to in a timely fashion and frequently approved. One hundred fifty seven (44%) respondents rated the HMO that they worked with as above average or the best while 97 (27%) rated it as below average or the poorest. Respondents' criticisms of their HMO focused on failures to make useful treatment suggestions and a lack of understanding regarding the limited availability of community resources that could be alternatives to treatment. Therapist attitude was more favorable when pre-authorization was sought from the HMO directly rather than through a gatekeeper. Conclusion: The pre-authorization requirement for outpatient services is not an undue burden for the mental health/alcohol and other drug abuse providers or patients. Wisconsin Medical Journal Volume 103, Number 6 - 2004
Survey suggests partnering relationships will improve
Access can be defined as timely patient contact with appropriate providers of needed health services. Timely contact facilitates early diagnosis and treatment. Appropriate providers mean culturally competent practitioners with necessary clinical skills. Needed health services should result in improving the health status of the population being served. Access is centrally important because it correlates with quality of care and health outcomes. Wisconsin Medical Journal Volume 103, Number 6 - 2004
