HOUSE RESOLUTION REQUESTING THE AUDITOR GENERAL TO OVERSEE AN AUDIT OF MEDICAID PROGRAMS ADMINISTERED BY MANAGED CARE ORGANIZATIONS
If the audit indicates that a fee-for-service program could yield better access, savings, and healthcare outcomes, the resolution compels the Office of Health and Human Services and the Auditor General to create a transition plan within two years. This transition would mean that the state would take control over Medicaid administration, instead of allowing managed care organizations to operate under the current system. The proposed change could impact how Medicaid beneficiaries receive services and challenge the existing models of healthcare delivery in Rhode Island.
House Bill H7689 is a legislative resolution that requests the Rhode Island Auditor General to oversee an audit of Medicaid programs administered by managed care organizations. The bill highlights concerns regarding the adequacy of access to specialists for individuals with disabilities, chronic diseases, or psychological trauma under current managed care arrangements. The primary intent of the resolution is to evaluate whether these organizations are providing effective healthcare services and achieving better outcomes compared to a state-managed fee-for-service Medicaid program.
The discussions surrounding H7689 may involve significant contention among stakeholders, particularly between proponents of managed care and advocates for a publicly-managed Medicaid program. Supporters of the bill argue for the need to ensure that vulnerable populations receive adequate healthcare services, while opponents may contend that a state-run program could lead to inefficiencies and higher costs. Another point of debate could be the implications of enforcing stricter Medical Loss Ratios (MLR) on managed care organizations, as well as penalties for non-compliance with contract terms.