The office conducted an online survey requesting information from all states with Medicaid managed care plans subject to federal MLR requirements, according to the Sept. 22 report. Forty-three states submitted survey responses and plans’ annual MLR reports from September to December 2020. The office reviewed the survey responses and analyzed plans reports for completeness.
Five things to know:
1. Forty-nine percent of the 495 reports reviewed by the inspector general’s office were incomplete.
2. Incomplete reports were missing at least one of the seven numeric data elements “that are essential to the MLR.”
3. States indicated they reviewed the reports for completeness, but few states identified incomplete reports.
4. Twenty six states said they reviewed MLR data elements for accuracy for all their plans. Sixteen states said they did not review the accuracy of MLR data elements for all or some of their plans.
5. The inspector general’s office recommended that CMS strengthen states’ oversight of MLR reporting by designing a template for states to provide to the Medicaid managed care plans. It also recommended that CMS clarify states verify the completeness of their plan’s MLR reporting requirements, clarify that states should review reports to verify accuracy of data elements, and provide additional guidance to states regarding plans’ reporting of non-claims costs in reports. CMS concurred with the recommendations.
