August 30,2019

Grassley, Casey Probe Federal Oversight of Medicaid Managed Care Organizations

WASHINGTON – Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Senate Aging Committee Ranking Member Bob Casey (D-Pa.) today wrote to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma and eight external quality review organizations (EQROs) that audit managed care organizations (MCOs) regarding the implementation of reforms outlined in a 2017 Government Accountability Office (GAO) report on improving access and quality in states’ Managed Long-Term Services and Supports (MLTSS) programs, as well as implementation of guidance provided by CMS in 2013.

Due to several factors in recent decades, seniors and people with disabilities on Medicaid are increasingly receiving long-term services from managed care organizations (MCOs) through home and community based services (HCBS). These shifts have brought significant changes.

“In order to ensure these changes do not cause disruptions for vulnerable people who tend to have significant health care needs, it is incumbent upon CMS and states to ensure adequate oversight,” Grassley and Casey wrote. “Managed care has the potential to improve outcomes and save money by streamlining health care services, and in many cases that has been documented. However, the Medicaid managed care program must be responsive to the unique needs of those beneficiaries with disabilities who depend upon MLTSS.”

In 2013, CMS issued guidance for states seeking to implement managed care arrangements for LTSS programs. Grassley and Casey are requesting information from CMS about the agency’s oversight of these arrangements and if the guidance is being followed by states and managed care organizations. Grassley and Casey are also seeking information regarding CMS’ implementation of recommendations outlined by GAO.

Grassley and Casey are making similar requests of the EQROs that audit the Medicaid managed care program. The senators are seeking information about the EQROs’ oversight of managed care organizations, including their auditing and review processes and transparency practices.

Find the senators’ letter to CMS HERE, their letters to the EQROs HERE.