
A new Government Accountability Office (GAO) report on the use of prior authorization (PA) for behavioral health services in Medicare Advantage (MA) found that of the 9 MA organizations reviewed, most required PA for inpatient and partial hospitalization care. Nearly all MA plans under review used internal coverage criteria for PA decisions, especially for inpatient care. GAO recommends that CMS target behavioral health services in its program audit reviews of PA denials and planned reviews of internal coverage criteria, scheduled to begin in 2026.