Audit: More oversight needed of Medicaid managed-care firms
By MELINDA DESLATTE
Oct. 23, 2017
BATON ROUGE, La. (AP) — Louisiana's health department doesn't properly monitor managed-care organizations that provide services for most state Medicaid patients to ensure they have enough specialists to treat mental health problems and drug addiction, according to an audit released Monday.
The report from Legislative Auditor Daryl Purpera's office comes as the health department is asking lawmakers to extend the contracts with the managed-care companies for another two years, deals carrying an estimated price tag of $15.4 billion in federal and state dollars.
Auditors said they found 45 percent of providers listed by managed-care groups as licensed mental health professionals from October through December 2016 didn't meet licensing requirements, raising questions about the services provided. The Department of Health said the figure was inflated and that it has verified licensure of more than half of those questioned.
The audit also raised concerns about whether the health department was double-checking information given by the managed-care organizations to ensure it accurately reflects available providers and services.
The private managed-care companies coordinate services for 90 percent of Medicaid recipients, nearly 1.5 million people — pregnant women, children and adults who receive the government-financed coverage through the Medicaid expansion program.
The report looked at access to specialized behavioral health providers, such as psychologists and licensed clinical social workers, for patients with mental health problems and substance abuse issues.
The health department "needs to strengthen its monitoring activities" to make sure the managed-care companies have an adequate network of those providers who are "licensed and qualified," auditors wrote.
Health department officials responded that they've tightened oversight of the managed-care organizations, issuing $44,000 in fines since July for companies failing to accurately report information about mental health and drug abuse treatment services.
"Ensuring that individuals understand their options for care and are receiving the appropriate services from the appropriate, licensed providers is a priority," Michelle Alletto, deputy secretary of the agency, said in a statement Monday.
But Alletto also said improving oversight is difficult because of staffing cuts during former Gov. Bobby Jindal's administration that have left the department with only four employees who monitor the behavioral health services at issue in the audit.
Criticism of the managed-care companies hits at an inopportune time for the health department, which is proposing 23-month extensions for the contracts enacted by the Jindal administration in 2015. Gov. John Bel Edwards' administration is proposing to continue them through December 2019 while working to seek new bids for managed-care work.
Lawmakers delayed a decision on the contract extensions last week, saying they wanted more details about deals that are among the largest in state government.
Louisiana pays a per-member, per-month fee for each Medicaid patient enrolled in a health plan with the companies. The enrollees get services through a network of primary care doctors, specialists and hospitals.
Jindal moved to the insurance-based model in 2012. Health department officials said the shift lessened growth in Medicaid costs by better coordinating care for patients. They said the contract extensions have been rewritten to include more accountability and link more payments to health quality metrics.
Purpera's office said it conducted the review after a 2015 survey ranked Louisiana 47th among states for access to behavioral health services. More than one-third of Louisiana's population receives health coverage through Medicaid.
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