Our first effort for 2022 of OMHP-PAC was the creation of a bill which protects the rights of mental health care providers in an insurance audit, whether from a private insurance company or a Coordinated Care Organization. This bill had support to pass and was well on its way, but because the Republicans walked out during session, the bill died. Its back this year.
The following is the 2022 draft that was circulated and is being brought back for 2024. This bill addresses the increase in insurance audits since 2019, recognizing the detrimental affect that this has had on client care. Audits are confusing with unclear requirements. Many solo and group practices have chosen to opt out of providing insurance based services due to the financial risk of rigorous and confusing audits, while others have reported significant financial clawbacks and stressful audits stretching over many months that have impacted their ability to provide services. Often requirements are so unclear, extensive and confusing that documentation gets in the way of providing care. This limits access to care for clients and limits our state's ability to provide services to clients in need. While we recognize the need for audits in maintaining accountability to managed care organizations and quality care to our clients, we also believe it is imperative to assert our right for transparency, clarity and fairness in managed care audits to protect our ability as mental health providers to continue providing quality services to clients, and to attract more providers to the field.
The current draft of the provider rights bill:
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Places limitations on the amount of time an insurance agency or CCO can go back to audit records
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Requires that audits be completed by a mental health professional
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Asks that authorizations approved for medical necessity cannot later be denied for medical necessity in a later audit
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Requires that insurance companies allow providers the opportunity to rectify mistakes found in an audit
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Requires that insurance companies put all audit requirements in writing, with examples of correct documentation
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Requires that mental health providers may not be held liable for audit requirements not provided in writing
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Requires that insurers must notify providers 30 days in advance of any change in audit requirements before being held to the new standard
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Asks to end the practice of insurers applying sampling methods to recover fees in an audit for mental health practices
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Require that insurers may not audit a provider more than once without an opportunity to correct errors and move forward; that is, the insurer must wait until that audit is completed and may only audit on a date past completion of any corrective action plan
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Requires that auditors may not be financially incentivized to recover funds
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Allow providers to request a reasonable payment plan of up to three years for refunds requested by the insurance company as the result of an audit (other than for double payments.)
As this bill is reviewed by legislators and others, we will update our members in changes and refinements to the bill.
If you believe in supporting this bill, please donate to help us move this bill through the legislature.