Managed Care Denials Draw Scrutiny of Medicaid Advisers

Medicaid policy advisers are contemplating a series of recommendations that would address growing concerns over high rates of denials in Medicaid managed care.

The Medicaid and CHIP Payment and Access Commission on Thursday discussed options to improve oversight and transparency of Medicaid managed care organization (MCO) denials and appeals processes.

These included requiring states to collect data on denials and appeals outcomes, overseeing and auditing denials for clinical appropriateness, and including MCO denial data on state quality rating system websites. MACPAC is a legislative agency that provides policy and data analysis and makes recommendations to Congress.

Of the 57 million ...