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Report Advocates Strong State Oversight for Managed Care Programs

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Report Advocates Strong State Oversight for Managed Care Programs

August 13, 2012

The report Keeping Watch: Building State Capacity to Oversee Medicaid Managed Long-Term Services and Supports, issued by the AARP Public Policy Institute, says that effective oversight is key for ensuring access to care for states using managed care organizations to serve seniors and individuals with disabilities enrolled in Medicaid.

Many MCOs lack experience coordinating long-term supports and services for their Medicaid enrollees, which can result in less access to care when cost-controlling measures are enacted. The report advises states to focus on five core areas to effectively oversee their MCOs to avoid sacrificing quality of care and that 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 
  • Ensure actuarially sound rates that pay program contractors appropriately to ensure financial stability and access to necessary services and providers.