Behavioral health is a major public health issue in the District of Columbia. Sadly, many of the legislative and regulatory initiatives around behavioral health are tied to other public health concerns, such as opioid addiction, maternal mortality, and health equity.

In partnership with the Washington Psychiatric Society, AMA, and American Psychiatric Association (APA), MSDC works to ensure that patients receive appropriate support for behavioral health issues, that the practice of psychiatry is supported in the District, and that psychiatrists are available to patients in the District.

MSDC was a proud supporter of the Behavioral Health Parity Act of 2017, which enshrined into law that all health plans offered by an insurance carrier meet federal requirements of the Wellstone/Domenici Mental Health Parity and Addiction Equity Act of 2008.

MSDC Statements and Testimony of Behavioral Health Issues

25th Council period information coming soon

Report: DC MCO Had 20% Prior Auth Denial Rate

Sep 7, 2023, 16:56 PM by MSDC Staff

A report using 2019 data showed that DC MCOs had high prior auth denial rates but DC lacked enforcement or review.

In 2019, a DC Managed Care Organization (MCO) denied 20% of prior authorizations submitted, higher than any other state.

A recently published report by the Department of Health and Human Services (HHS) Office of the Inspector General reveals the District government lacks recommended oversight procedures for overseeing prior authorizations in the managed care system. In 2019 - the most recent year for data - that led to very high rates of denials by District MCOs. See the entire report here.

The report comes from Congressional requests to HHS on how MCOs are providing patient care. The OIG reviewed data from the largest MCOs nationally and compared their denial rates nationally and at the state level. For DC, this meant AmeriHealth and Amerigroup were included in the study. The most recent year data was available was 2019.

Nationally, AmeriHealth Caritas had a prior auth denial rate of 6.1%. DC's denial rate was 20%, the highest in any state AmeriHealth served. Anthem, Amerigroup's parent company, had a 12.9% denial rate nationally but "only" a 14.1% denial rate in the District.

Even more disturbing is the lack of documented oversight into this process by the District government. The study looked at three oversight categories:

States regularly reviewed prior authorization denials for appropriateness
State used denials data for oversight
State offered external medical reviews

DC did not meet the criteria for the second or third, and was labelled as "ad hoc" for the first.

This data shows the importance of ensuring all payers, including the MCOs, are included in B25-124, the Prior Authorization Reform Amendment Act. You can help us pass this important legislation by:

Attending our Council Visit Day to provide your perspective.
Contacting your Councilmember's office.
Sharing your story with MSDC and volunteering to sit for a media interview on the topic.

Sample of Legislation MSDC is Tracking in Behavioral Health

(see the whole list of bills here)

Suicide Prevention Continuing Education Amendment Act of 2019 (B23-543)

What does it do? The bill requires licensed health providers to complete 2 hours of CME on suicide prevention, assessment, and screening.

MSDC position: MSDC opposes the bill as written as the language does not encourage physician wellbeing or sufficient awareness of suicide prevention.

Current status: The bill had a hearing with the Committee on Health on June 10.