Bill > SCR116

This Concurrent Resolution requests the State Auditor to conduct a thorough financial and performance assessment of the managed-care organizations, which are private companies that manage and administer the state's Medicaid program, known as Med-QUEST in Hawaii. The assessment will specifically examine how much money is spent on actual healthcare services versus administrative costs, with a particular focus on separating "medical management" expenses and costs related to payment reforms from payments made to healthcare providers. The Auditor will also evaluate if the networks of doctors and hospitals offered by these managed-care plans are adequate by performing "secret shopper" surveys to verify if listed providers are actually accepting Medicaid patients, and will investigate whether the managed-care plans are improperly "upcoding" diagnoses to inflate payments from the state based on risk adjustment formulas. Finally, the Auditor is required to submit a report of their findings and any legislative recommendations to the Legislature before the start of the 2023 regular session.