Valley Providers Heap Scorn on Medicaid Managed Care

A hearing of the Sunset Commission

The Statesman published an article this morning about the scathing testimony heard by the House Committee on Human Services, chaired by Rep. Richard Peña Raymond, at a special hearing held yesterday in Edinburg.

Wanted public and provider feedback on managed care

The Committee traveled to the Valley to hear testimony from Medicaid providers and public about “the impact managed care has had on the quality and cost of health care throughout the state, and review initiatives that managed care organizations have implemented to improve the quality and care.” The hearing was held at the Edinburg Conference Center at Renaissance.

The Rio Grande Guardian had previously reported that the hearing mandate included:

  • Whether access to care and if network adequacy contractual requirements are sufficient;
  • Provider and Medicaid participants’ satisfaction within STAR, STAR Health, Star Kids, and STAR+Plus managed care programs; and
  • The Health and Human Services Commission’s oversight of managed care organizations to make recommendations for any needed improvement.

Paid late, overloaded with paperwork, deny critical care

Per the Statesman article, the complaints could be summarized as “pay providers late, overload them with paperwork and deny their patients access to critical care.”  No dentists apparently testified.

“Texas Medicaid managed care system faces great but surmountable challenges that must be addressed with all due haste, beginning with enhanced scrutiny not only of the health plans but also how the state’s own actions — including deep funding cuts and insufficient agency staff — jeopardize Medicaid’s ability to care for the neediest among us,” Carlos Cardenas, an Edinburg gastroenterologist and a member of the Texas Medical Association, told the committee.

Managed care organizations fined millions of dollars

Some interesting facts came out of the hearing.

The Statesman reported that Stephanie Muth, HHS deputy executive commissioner, said her agency “has assessed more fines each year against managed care organizations. In 2009, the agency assessed $1.6 million in liquidated damages, and in the first three quarters of 2017, the agency assessed $27.4 million.”

Also, Muth told the hearing that HHS has “freed up $4.5 million to add 98 employees over the next two years to contract oversight” to finally overcome the continuing criticism of agency performance in this area.

The full article can be read here.


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