West Virginia University Details Findings in Managed Care (Clinical and Administrative Perspectives On Prior Authorization for Residential Substance Use Disorder Treatment: a Qualitative Analysis): Managed Care

2025 SEP 18 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Fresh data on Managed Care are presented in a new report. According to news reporting from Morgantown, West Virginia, by NewsRx journalists, research stated, “The objective of this study was to describe the clinical experiences associated with billing for short-term residential care for substance use disorder (SUD) under a Medicaid managed care organization (MCO) payment structure requiring prior authorization. The authors conducted a qualitative analysis of focus group data collected from residential adult services (RAS) facilities staff in West Virginia between 2020 and 2022.”

Financial support for this research came from West Virginia Department of Human Services.

The news correspondents obtained a quote from the research from West Virginia University, “These primary data were derived from 17 semi-structured focus groups across 11 distinct RAS facilities, which included 28 administrators, 23 clinicians, and 10 peer recovery support specialists, and were recorded and transcribed before being coded. A phenomenological thematic analysis was employed using data describing reported experiences of RAS staff members billing MCOs under the 1115 Medicaid SUD Waiver. Two main themes arose related to billing MCOs for residential treatment. First, providers felt powerless in their roles as their focus moved from clinical to administrative due to the administrative burden of prior authorizations. Second, providers felt that the shorter lengths of stay for patients that resulted from the prior authorization requirements reduced the quality of care they could provide and that the low quality of care increased the risk of relapse among patients. Thus, MCOs’ utilization of prior authorization as a cost management tool may create barriers for providers to fulfill their clinical roles and provide high-quality care.”

According to the news reporters, the research concluded: “More research is needed to investigate the prior authorization process from the perspective of MCOs and to quantify the effects of prior authorization on patient outcomes.”

This research has been peer-reviewed.

For more information on this research see: Clinical and Administrative Perspectives On Prior Authorization for Residential Substance Use Disorder Treatment: a Qualitative Analysis. The Journal of Behavioral Health Services & Research, 2025. The Journal of Behavioral Health Services & Research can be contacted at: Springer, One New York Plaza, Suite 4600, New York, Ny, United States.

Our news journalists report that additional information may be obtained by contacting Rebecca Wallis, West Virginia University, Hlth Affairs Inst, 64 Med Ctr Dr, Morgantown, WV 26506, United States. Additional authors for this research include Herb Linn, Anh Ngo, Yilin Cai, Carrie Speck, Lindsay Allen, Stephen M. Davis and Thomas Bias.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1007/s11414-025-09956-0. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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