States should have strong oversight over Medicaid managed care programs, report asserts

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States should have strong oversight over Medicaid managed care programs, report asserts
States should have strong oversight over Medicaid managed care programs, report asserts

Effective oversight is the key to ensuring access to care for states using managed care organizations for elderly and disabled Medicaid enrollees, a new report suggests.

Most managed care organizations (MCOs) have little experience coordinating long-term services and supports for members of the Medicaid population. As a result, cost-cutting efforts could restrict access to care, an AARP official said at a recent forum sponsored by the Alliance for Health Reform. A new AARP report recommends five core areas upon which states should focus oversight efforts.

According to the AARP, states should: closely monitor long-term services and support contracts through on-site audits or auditing software; employ “mystery shoppers” to make sure providers and benefits are accessible to enrollees; use electronic visit verification systems to monitor home care delivery; conduct member education programs and take advantage of ombudsman programs; and pay close attention to rate setting procedures to ensure costs don't restrict access, the report states.

The beneficiaries enrolled in MCOs often are dually eligible Medicare and Medicaid recipients who have multiple chronic conditions. Currently, 16 states use managed care programs, the Bureau of National Affairs reported.

Click here to read the full AARP report.

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