Requesting The Auditor To Conduct A Financial And Performance Assessment Of The Managed-care Organizations That Administer The State's Medicaid Program.
The proposed assessment aims to uncover potential discrepancies in how funds are allocated between health care payments and administrative services within the managed care framework. A significant aspect of the assessment involves distinguishing 'medical management' costs from direct healthcare provisions, which some argue have inflated administrative costs that unnecessarily burden the health care system. Additionally, the resolution indicates that managed care plans often present inaccurate provider lists, leading to confusion for beneficiaries seeking necessary care.
HCR142 is a resolution introduced in the Hawaii Legislature that requests the state auditor to conduct a comprehensive financial and performance assessment of the managed-care organizations responsible for administering Hawaii's Medicaid program. The resolution highlights the need for this assessment in light of concerns regarding the efficiency and transparency of these organizations, particularly their compliance with regulatory standards and their impact on service delivery to Medicaid beneficiaries. It underscores the need for high-quality, affordable healthcare for all beneficiaries, especially following job losses and insurance disruptions caused by the COVID-19 pandemic.
Supporters of HCR142 argue that a thorough audit could lead to greater accountability among managed-care organizations and improve access to necessary services for vulnerable populations. Conversely, there may be opposition from stakeholders within the health insurance industry who could view the audit as an encroachment into their operations. Concerns about confidentiality, competitive practices, and the potential for increased regulatory oversight could emerge during discussions surrounding the execution of this assessment.
Specific provisions of HCR142 include requests for network adequacy evaluations through 'secret shopper' surveys to validate the participation of purported network providers and assessments of potential upcoding practices by managed care plans, which affect reimbursement rates based on misrepresentations of patient conditions. The auditor's findings and any recommendations for legislative changes are to be submitted to the legislature prior to the convening of the next regular session, ensuring timely scrutiny and responsiveness to the identified issues.