Bill > HCR142

This Concurrent 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, known as Med-QUEST. The assessment will specifically examine how much MCOs spend on actual healthcare services versus administrative costs, including separating "medical management" expenses and the administrative burden of payment reforms from payments to healthcare providers. The Auditor will also evaluate the accuracy of MCO provider networks through "secret shopper" surveys to see if claimed network physicians are actually accepting Medicaid patients, and investigate whether MCOs are improperly "upcoding" patient diagnoses to increase payments from the state based on risk adjustment formulas. Finally, the Auditor is required to submit a report with findings and recommendations, including potential legislative changes, to the Legislature by a specific date.