Bill > SR103

This Resolution requests the State Auditor to conduct a thorough financial and performance assessment of the managed-care organizations (MCOs) that manage Hawaii's Medicaid program, which provides health coverage to eligible residents. The assessment will specifically examine how much MCOs spend on actual healthcare services versus administrative costs, including separating "medical management" expenses and costs associated with payment reforms from payments made to doctors and hospitals. Additionally, the Auditor will investigate the accuracy of MCO provider networks through "secret shopper" surveys to verify if listed physicians are actually accepting Medicaid patients, and assess if MCOs are improperly inflating payments from the state's Med-QUEST program through "upcoding" based on risk adjustment formulas. The findings and any legislative recommendations will be reported to the Legislature before the 2023 session.