Following a mid-July report by the Office of Inspector General (OIG) revealing high rates of prior authorization denials in Medicaid Managed Care, there was interest from Congress. In early August Congressman Pallone (D-NJ) announced that he would investigate the MCOS rendering denials about twice as often as Medicare Advantage Plans. Since initially announced, Senator Wyden (D-OR) has joined Congressman Pallone in sending letters to each managed care organization outlined in the OIG report. The updated announcement is available here. Letters to each MCO are available: Aetna Inc.; AmeriHealth Caritas; CareSource; Centene Corporation; Elevance; Molina Healthcare Inc.; United Healthcare.
Senator Casey separately sent a letter to CMS Administrator Brooks-LaSure on October 3rd, citing the OIG report and outlining concerns that MCOs are improperly denying coverage that can negatively affect patient outcomes. The letter goes on to note individual experiences with service denials while also touching on the effects on providers resulting in wasted staff time, delayed treatment, and payment debates for rendered services. From his concerns, Senator Casey asks the Administrator for answers to questions about how CMS is responding to recommendations from the OIG, how access to services is being assured, how participants are made aware of appeal and fair hearings rights, among others. Read the letter here.
