H.R. 142 Summary

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

• Audit administrative costs versus health care payments, with particular focus on separating "medical management" administrative costs and payment reform costs from provider payments

• Conduct "secret shopper" surveys to assess network adequacy by determining how many physicians claimed as network providers actually accept Medicaid patients

• Assess the extent of upcoding by Medicaid managed care plans to increase payments through risk adjustment formulas that reward over-diagnosis

• Submit findings, recommendations, and any proposed legislation to the Legislature no later than twenty days before the start of the 2023 Regular Session