GAO Urges CMS to Collect Better Data on Appeals, Grievances in Managed Medicaid

Comprehensive information about appeals of coverage denials by Medicaid managed care organizations is not available, and state and federal officials are far from setting a common, national data standard, according to a March report from the Government Accountability Office (GAO). The report reiterates some of the same conclusions made by another federal watchdog, the HHS Office of Inspector General (OIG), in a July 2023 report about Medicaid MCOs’ prior authorization denials, and experts say they do not expect data reporting to improve in the short term.

Medicaid MCOs are facing increasing regulatory pressure over prior authorization and other utilization management (UM) practices, particularly at the state level. Federal lawmakers have yet to approach Medicaid UM reforms with the same bipartisan zeal that they have brought to revamping Medicare Advantage practices. But the new GAO report, which was prepared at the request of Sen. Ron Wyden (D-Ore.) and Rep. Frank Pallone (D-N.J.) is an indication that powerful Democratic members of Congress are taking interest in reforming UM in managed Medicaid.

0 Comments
© 2024 MMIT
Peter Johnson

Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

Related Posts

audit
March 15

Medicaid Officials Warn Insurers: Reform Prior Auth Before Politicians Do

READ MORE
medicaid
July 28

Medicaid MCOs Often Deny Prior Authorization Requests, OIG Report Says

READ MORE
centene-hq
January 18

Contract Terminations Signal Tougher CMS Enforcement Amid Stars Upheaval

READ MORE

GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND

Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today