Georgia bill seeks to impose spending threshold on managed care organizations

A bipartisan bill in Georgia's House of Representatives would require managed care organizations to reimburse the state if they spent too little on medical care or quality improvements, according to Kaiser Health News

The move would align Georgia with most other states, which set spending thresholds for their managed care organizations. 

Currently, 36 of 42 states that use managed care organizations have medical loss ratio thresholds. Most states set an 85 percent medical loss ratio benchmark, and Georgia's bill would do the same in an effort to make sure more money goes toward residents. 

The bill would affect CareSource, Peach State Health Plan and Amerigroup — the state's three current managed care organizations — and future entities looking for a share of the $4 billion state health insurance program. 

According to Kaiser Health News, the bill could have required Peach State Health Plan, the largest of the three entities, to refund the state for slipping below an 85 percent medical loss ratio from 2018 to 2020.

Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Top 40 articles from the past 6 months