2024 -- H 7689

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LC005062

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

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H O U S E   R E S O L U T I O N

REQUESTING THE AUDITOR GENERAL TO OVERSEE AN AUDIT OF MEDICAID

PROGRAMS ADMINISTERED BY MANAGED CARE ORGANIZATIONS

     Introduced By: Representatives Solomon, and Stewart

     Date Introduced: February 15, 2024

     Referred To: House Finance

     WHEREAS, Managed care is defined as “a healthcare insurance approach that integrates

the financing of health care and the delivery of care and related services to keep the costs to the

purchaser at a minimum while delivering what is appropriate for a given patient or population of

patients”; and

     WHEREAS, Managed care organizations, also known as health maintenance

organizations, are prepaid health plans that furnish care through a network of providers under a

fixed budget and managed costs; and

     WHEREAS, Oftentimes, managed care organizations are not providing people with

disabilities, chronic disease, or psychological trauma adequate access to needed specialists who

are qualified to diagnose and treat their conditions; and

     WHEREAS, There is an urgent need to determine whether managed care entities in

Rhode Island are providing savings, as well as access and outcomes that are better than what

could be obtained under a fee-for-service program that is managed by the state; now, therefore be

it

     RESOLVED, That this House of Representatives of the State of Rhode Island hereby

requests the Auditor General to oversee an audit of the Medicaid programs administered by

managed care organizations, and report findings to the House and the Director of the Executive

Office of Health and Human Services (EOHHS) within six (6) months of the passage of this

resolution; and be it further

     RESOLVED, That this House hereby further requests that if the Auditor General

concludes that a fee-for-services state-run Medicaid program could provide better savings, access,

and outcomes than the current managed care system, the Office of Health and Human Services

and the Auditor General would develop a plan for the State to transition to a state-run fee-for-

service program within two (2) years from passage of this resolution; and be it further

     RESOLVED, That said state-run fee-for-service program would:

     • Allow the state to transition to a fee-for-service state-run Medicaid program within two

(2) years from the passage of this resolution;

     • Require managed care entities to meet a medical loss ratio (MLR) of greater than ninety

percent (90%) net of pharmacy benefit manager costs related to spread pricing;

     • Require managed care entities to remit to the state Medicaid program excess capitation

revenues that fail to meet the ninety percent (90%) MLR; and

     • Set forth penalties for failure to meet contract terms; and be it further

     RESOLVED, That the Secretary of State be and hereby is authorized and directed to

transmit duly certified copies of this resolution to The Office of the Auditor General, and the

Executive Office of Health and Human Services (EOHHS).

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LC005062

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