Bill > HR142

This Resolution requests the State Auditor to conduct a comprehensive financial and performance assessment of the managed-care organizations (MCOs) that administer Hawaii's Medicaid program, which provides health coverage to eligible low-income residents. The assessment will involve auditing how much MCOs spend on actual healthcare versus administrative services, specifically scrutinizing costs related to "medical management" and payment reforms, and will also include "secret shopper" surveys to verify if listed network physicians are actually accepting Medicaid patients, addressing concerns about inaccurate provider lists. Furthermore, the Auditor will investigate whether MCOs are engaging in "upcoding," a practice of inflating diagnoses to receive higher payments from Hawaii's Med-QUEST program, and will submit a report with findings and recommendations to the Legislature by early 2023.