Privacy Issues in Mental Health and Substance Abuse Treatment: Information Sharing Between Providers and Managed Care Organizations: Final Report. 1. Variation By Type of Plan

01/17/2003

Some respondents believe that the information requested varies by the type of plan.  We reviewed whether the types of information requested varies by whether an MCO does or does not carve out behavioral health (Appendix E).  While our data are limited, with only four examples from MCOs and seven from MBHOs, there do not seem to be any differences in the types of patient information requested by the two types of MCOs.

Table II.1
Patient Health Information Commonly Requested in Outpatient Treatment Authorization, by Type of Response 
Total Examined—11
Requested Informationa Categorical Narrative Both
Demographic/Administrative Information
Patient’s name   11  
Patient’s date of birth   10  
Patient’s social security/insurance ID number   10  
Practitioner’s name, address, phone   11  
Practitioner’s license and/or ID number   10  
Initial authorization or continuing 6 1  
Length of treatment/start and end dates   8  
Diagnosis
DSM-IV diagnosis code 11    
Current Global Assessment of Functioning (GAF) 10    
Highest GAF in past year 8    
Patient History
Previous MH/SA treatment 2 4 2
History of substance abuse 2 5 1
Presenting Problems
Symptoms 7 2 2
Duration and severity of symptoms 6 1  
Risk assessment suicide/homicide 5   3
Current substance abuse 5 1 3
Family/social relationships 4 2 2
Job/school performance 4 2 2
Obsessions/compulsions 4   2
Treatment Information
Requested procedures/types of services 8 1 2
Frequency/duration of treatment 4 7  
Expected treatment outcomes 4 5  
Member notified/concurs with goals? 5 1  
Medications
Current medications 2 8  
Dosage/frequency 1 7  
Compliance 3 3  
Care Coordination
Communication with PCP 6 1  
Patient receiving other community services 4 3 2

aItems are included in table if they were listed in 6 of 11 examples studied


We also reviewed whether local MCOs request different types of patient health information from the national firms for which we had information (Appendix F).  Two providers noted that, in their experience, local MCOs tend to ask for less detailed information than do national firms.  One said that the likely reason for this is that the local MCOs are more familiar with her clinic and have a closer working relationship with the providers.  Again, this analysis is limited because we have examples only from five national managed care firms and six local firms.  However, there do not seem to be any differences in the types of patient information requested by local or national MCOs.  However, beyond these forms, MCOs request follow-up information on certain cases in an informal manner, and it is possible that less follow-up information is requested if a provider develops a strong working relationship with an MCO.  Stronger working relationships could, in turn, be easier for providers to develop with local MCOs.

Two of the outpatient treatment request forms we examined were geared specifically toward substance abuse treatment.  There were too few of these forms to do a separate analysis, but in comparing them to the others, we found that the only difference is that these two forms do not ask about the patient’s risk of suicide or homicide.  Otherwise, information requested in these forms does not differ from information requested for general behavioral health.  In addition, two of the forms we looked at were from Medicaid managed care plans.  These forms ask for the same types of patient information as commercial managed care plans.

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