Requesting The Auditor To Conduct A Financial And Performance Assessment Of The Managed-care Organizations That Administer The State's Medicaid Program.
SCR116 highlights challenges within Hawaii's current healthcare insurance system, such as excessive prior authorizations, restrictive formularies, and inadequate physician networks. By addressing these issues, the bill aims to improve physician participation and reduce administrative burdens that have made it difficult for hospitals and providers to operate efficiently. The resolution specifically requests an evaluation of the financial discrepancies between payments for healthcare versus payments for administrative services, aiming to identify and mitigate excessive bureaucracy in the system.
Senate Concurrent Resolution No. 116 (SCR116) requests an audit of the managed-care organizations (MCOs) that operate within Hawaii's Medicaid program. This resolution underscores the need for a thorough financial and performance assessment of these organizations to ensure they are providing quality healthcare at reasonable costs. The resolution advocates that every Medicaid beneficiary should receive high-quality, publicly provided, and affordable health care, emphasizing the importance of healthcare access without discrimination.
The findings from the audit will be crucial in shaping future health policies in Hawaii, as the Auditor is expected to report their findings and recommendations to the legislature ahead of the next legislative session. The resolution also calls for the state to support families, particularly in the wake of healthcare disruptions caused by the COVID-19 pandemic. Overall, SCR116 aims to enhance the effectiveness of Medicaid services in Hawaii by pushing for greater oversight and accountability of managed care organizations.
A critical point of contention involves the concern that the current system incentivizes practices such as 'upcoding', where Medicaid managed care organizations may exaggerate the severity of diagnoses to receive higher payments. SCR116 seeks to address these practices head-on by authorizing the auditor to investigate network adequacy and ensure that reported networks of physicians are actually accessible to Medicaid patients. This contention is essential not only for financial fairness but also for ensuring that vulnerable populations receive the care they need without barriers.