HI HCR142

Request the State Auditor to conduct a financial and performance analysis of managed care organizations administering Hawaii's Medicaid program.

Audit healthcare payment amounts versus administrative service costs, specifically separating "medical management" costs and payment reform administrative costs from actual provider payments.

Assess network adequacy through "secret shopper" surveys to verify whether physicians listed as network providers actually accept Medicaid patients.

Evaluate extent of upcoding by Medicaid managed care plans to increase payments from Hawaii Med-QUEST through risk adjustment formulas that reward over-diagnosis.

Submit audit findings, recommendations, and any proposed legislation to the Legislature no later than twenty days before the 2023 Regular Session convenes.