Health Payer Intelligence June 29, 2022
Kelsey Waddill

CMS has made changes to its data collection processes for Medicaid managed care direct payments, but there is still room for improvement, according to GAO.

Despite CMS efforts to expand oversight of Medicaid managed care direct payments and the US Government Accountability Office’s (GAO’s) previous recommendations to improve processes, the direct payment process in Medicaid still suffers from missing information, according to a GAO report.

Typically, states fund managed care plans and these plans cover providers’ services. However, CMS allows direct managed care plan payments to providers, or state directed payments, that are based on state-determined quality measures. 

CMS provides some oversight for these state directed payments, but when GAO reviewed CMS data, documents, and guidance and interviewed the CMS...

Today's Sponsors

Oliver Wyman
Patient Bond

Today's Sponsors

Oliver Wyman

Today's Sponsor

Patient Bond

Topics: CMS, GAO, Govt Agencies, Insurance, Medicaid, Payer, Survey / Study, Trends
North Carolina Medicaid expansion legislation falls through
Humana acquiring Inclusa, expanding Medicaid services in Wisconsin
40 states now cover around-the-clock Medicaid HCBS as provided in assisted living
Humana inks deal to expand in Medicaid managed care
The Medical Crisis that Finally Convinced Republicans in North Carolina to Expand Medicaid