HI SCR116

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

Directs the Auditor to audit healthcare versus administrative payments, specifically separating "medical management" costs and payment reform administrative costs from direct provider payments.

Requires the Auditor to assess network adequacy through "secret shopper" surveys to verify how many physicians claimed as network providers actually accept Medicaid patients.

Directs the Auditor to evaluate upcoding practices by Medicaid managed care plans that may inflate payments from Med-QUEST based on risk adjustment formulas rewarding over-diagnosis.

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