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Advocates Urge More Government Oversight Of Medicaid Managed Care

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"It's a Medicaid managed care stampede of states. That's what it feels like," said Mitzi McFatrich, executive director of Kansas Advocates for Better Care. “It’s too quick."

In the District of Columbia, more than 150,000 people are enrolled in Medicaid managed care, including mentally ill adults. A federally-mandated group that makes recommendations about Medicaid policy in Washington created a subcommittee to track the impact of managed care on mental health. Its report, issued last year, concluded that the program was poorly administered, with minimal oversight and insufficient data available.

“I think we were shocked to find out how little oversight that there was,” said subcommittee chairman Shannon Hall, executive director of the D.C. Behavioral Health Association. “They had great contracts with the plans, but as far as we could tell, none of them were being actively monitored or enforced.”

Advocates across the country say they’re worried that a number of companies vying for state contracts have little or no experience dealing with people who need long-term care, and they fear that plans might try to restrict access to save money because many new members will require expensive services.

Moser, of the industry trade group, dismisses those concerns, saying that the plans support rigorous oversight and want to make sure members get the care they need. He said several companies have a decade or more experience with long-term services and other plans will learn from them.

While states are responsible for keeping an eye on Medicaid managed care plans, the federal Centers for Medicare & Medicaid Services is required to monitor how well the states are doing that. But CMS, too, has had its problems with oversight, according to reports by the Department of Health and Human Services Inspector General’s office and the U.S. Government Accountability Office.

In 2009, the Inspector General’s office found that CMS hadn’t enforced a requirement that states collect and report data that gives detailed information about services provided to individual Medicaid managed care patients.

The following year, the GAO criticized CMS for lax oversight and inconsistency in tracking how states set managed care plans’ rates. The auditors wrote that this was essential because it could “help avoid significant overpayments and reduce incentives to underserve or deny enrollees’ access to needed care.”

Wed, Jul 03 2013

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