Late in 2010, BlueCross BlueShield of Illinois (BCBSIL) announced that effective Jan. 1, 2011, it would implement a prior authorization policy for outpatient behavioral health services. In the wake of widespread objections from behavioral health providers and organizations, BCBSIL has announced that it is rescinding the prior authorization policy for most outpatient behavioral health services.
While the new policy does not require preauthorization for most outpatient behavioral health services, BCBSIL will still require preauthorization for several types of outpatient behavioral health services before initiation of these services. These include electroconvulsive therapy, psychological testing, partial hospital admissions and intensive outpatient programs. BCBSIL did not provide definitions for these services, leaving doubt as to how strictly or loosely it will interpret such terms as “psychological testing” and “intensive outpatient programs.” How BCBSIL chooses to interpret these terms will have a significant impact on the coverage of outpatient behavioral health services and could still result in widespread restrictions despite the official position reversing the preauthorization requirement.
Additional information about the BCBSIL prior authorization policy can be found in a Dec. 30 communication to providers and in a BCBSIL Frequently Asked Questions document. Click here to visit the Parity page of our blog for more information and resources.