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Federal investigators fault CMS for poor oversight of Medicaid managed care contracts
A Government Accountability Office report released Wednesday finds the agency that oversees Medicaid approved managed care contracts that might not have met federal requirements.
The report found regional gaps in oversight and in the data the states collect to ensure the rates insurance companies charge for the care of Medicaid beneficiaries are accurate.
The top Democrat and Republican on the Senate panel that has jurisdiction over Medicaid immediately called on the Centers for Medicare and Medicaid Services to increase its oversight.
"This report makes clear that we don’t have enough information to guarantee that prices are accurate and that Medicaid is protected," Finance Committee Chair Max Baucus (D-Mont.) said. "CMS has taken some steps to boost oversight, but this report makes clear that the agency needs to be more aggressive in its oversight of state contracts to ensure that care is coming at an accurate price. I intend to continue monitoring this issue to make sure that progress is being made and the Medicaid program is working effectively for Americans who need it.CMS has already made some changes as a result of the GAO’s findings, according to the senators, including requiring all regional offices to use a checklist when reviewing state’s rate-setting submissions. But they say more needs to be done.
The report raises questions with Medicaid contracts in two states in particular. Tennessee received $5 billion a year in federal funds for rates that had not been certified by an actuary, as required by federal regulations, the report says. And in Nebraska the Centers for Medicare and Medicaid Services (CMS) did not complete a full review of rate setting since new requirements became effective, leaving doubts as to whether they are in compliance.
