Medicaid: Oregon's Managed Care Program and Implications for Expansions
HRD-92-89
Published: Jun 19, 1992. Publicly Released: Jun 19, 1992.
Skip to Highlights
Highlights
Pursuant to a congressional request, GAO reviewed Oregon's current Medicaid managed care program and the state's proposed expansion of the program as part of a larger demonstration.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | If the Secretary of Health and Human Services decides to approve Oregon's Medicaid demonstration project, the Secretary should direct the Administrator, Health Care Financing Administration (HCFA), to require Oregon to demonstrate, by binding letters of intent or other means, that adequate health plan and physician capacity can be put in place to serve the expected client population before it allows Oregon to implement the project. Provider capacity relative to managed care enrollment should be monitored carefully throughout project implementation. |
Closed – Implemented
The agency decided just recently to approve Oregon's request, and it is requiring the state to submit evidence that health plan and physician capacity is adequate to serve the expected enrollment.
|
| Department of Health and Human Services | The Secretary of Health and Human Services, through HCFA, should direct Oregon to continue to improve quality assurance activities in the current program. Specifically, Oregon should intensify its efforts to improve the delivery and documentation of well-child screening services, which were identified as a weakness by Oregon Medical Professional Review Organization and GAO consulting physicians. Oregon also could increase the usefulness of its client satisfaction survey by revising the questionnaire and survey methods. |
Closed – Implemented
Approval of waiver requires state to have extensive data collection on service delivery and quality assurance plans submitted from all participating health plans.
|
| Department of Health and Human Services | The Secretary of Health and Human Services, through HCFA, should direct Oregon to improve its monitoring of contractor financial solvency in the current program, by: (1) developing reporting guidance for the contractors to ensure that the state's adopted solvency indicators measure comparable aspects of financial performance; and (2) adopting evaluation criteria in the form of ranges or limits for use in assessing solvency indicators. |
Closed – Not Implemented
Approval letter did not address this issue. HHS does not believe such oversight is necessary and has no plans to require Oregon or any other state to implement such monitoring activity.
|
| Department of Health and Human Services | The Secretary of Health and Human Services, through HCFA, should direct the Office of Medical Assistance Programs to require risk basis subcontractors of fully capitated health plans to meet standards for financial solvency. Specifically, entities subcontracting with fully capitated plans to provide a comprehensive range of services, including inpatient care, should be subject to the same solvency monitoring requirements as those for fully capitated plans. |
Closed – Not Implemented
Approval letter did not address this issue. HHS has no plans.
|
| Department of Health and Human Services | The Secretary of Health and Human Services, through HCFA, should require Oregon to meet Medicaid disclosure requirements in both its current Medicaid managed care program and the proposed demonstration project, if approved. |
Closed – Implemented
Approval letter specifically requires compliance in the proposed demonstration plan which will subsume the current program.
|
Full Report
Office of Public Affairs
Topics
ChildrenFinancial managementHealth insurance cost controlInternal controlsManaged health careMedicaidReporting requirementsState-administered programsSupplemental security incomeSurveysQuality of care