HI SR103

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

Audit the separation of health care payments from administrative services costs, including "medical management" costs and payment reform administrative expenses

Assess network adequacy through "secret shopper" surveys to verify how many physicians claimed as network providers actually accept Medicaid patients

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

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