Tag: Medicaid Managed Care

WASHINGTON – Some people enrolled in Medicaid managed care may not be receiving all of their medically necessary health care services, according to a new study from the Office of Inspector General.  There are three key factors causing concern, the OIG says: the high number and rates of denied prior authorization requests; the limited oversight of prior authorization denials in most states; and the limited access to external medical reviews.  What the OIG found  Overall,...

WASHINGTON – CMS has an opportunity to strengthen state oversight of reporting by Medicaid managed care plans on medical loss ratios (MLRs), according to a new report from the Office of Inspector General. States reported that most Medicaid managed care plans submitted MLR reports; however, the OIG found that 49% of the 495 MLR reports reviewed were incomplete. These incomplete MLR reports were missing at least one of seven numeric data elements that are essential to the MLR calculation....

TALLAHASSEE, Fla. – Providers in Florida believe new legislation aimed at improving the state’s Medicaid managed care program will provide much-needed stability in a state that has had a troubled relationship with the program in the past.  Introduced in January, House Bill 1165 and Senate Bill 1540 would require payers to reimburse providers at 100% of the state’s fee schedule for durable medical equipment and complex rehab technology.   “The cost of goods,...

AMSTERDAM, the Netherlands – Philips advised HME providers in a Dec. 15 letter to return to the company any recalled DreamStation 1 devices that patients return to them.  As part of litigation stemming from Philips’ voluntary recall of the devices, a Nov. 10 court order “identifies the various types of evidence that must be preserved and requires parties and nonparties, including (HME providers), to preserve such evidence” and a Nov. 19 court order “permits...

WASHINGTON - Most states did not provide complete or accurate payment data on managed care payments to the CMS Transformed Medicaid Statistical Information System (T-MSIS), which provides oversight of the Medicaid program, according to a recent report from the Office of Inspector General.  The data include the amounts paid, billed and allowed for every service provided to Medicaid enrollees, including those services provided through managed care, the primary delivery system for...

BUFFALO, N.Y. - NCART and Neighborhood Legal Services, a nonprofit that provides free legal services to people with low income and people with disabilities, are teaming up on a new effort to call out managed care organizations for their failures to follow Medicaid policies. Here's what Marge Gustas and Joe Clark, a paralegal and attorney, respectively, who will be speaking at the National CRT Leadership & Advocacy Conference on May 1, had to say about legal strategies to hold MCOs accountable. HME...

WASHINGTON - CMS should take steps to mitigate program risks in managed care, according to a new report from the Government Accountability Office.About 0.3% of the $171 billion that Medicaid paid managed care organizations for 2017 was improper, the GAO found.CMS's estimate of improper payments for managed care has limitations that are not mitigated by current oversight efforts, the GAO says. One component of the Payment Error Rate Measurement measures the accuracy of capitated payments made to MCOs....