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Summary: HB 1159 would require the Office of Contract Management (office) within the Health and Human Services Commission to investigate and review each managed care organizations (MCO) procedures for determining whether a Medicaid beneficiary should be enrolled in a STAR+PLUS home and community-based services and supports program. The office is required to review every contract or only those MCOs with a higher likelihood of inappropriate client placement based on a risk-based assessment process. The office must report to the Legislature on its findings each year and HB 1159 stipulates that if a service review results in a decision to recoup money from an MCO, a service provider that contracted with such an MCO cannot be held liable for the good faith provision of services based on authorization from the MCO that is recouped.
Analysis: HB 1159 requires more stringent oversight of MCOs to determine those MCOs that are putting Medicaid clients into STAR+PLUS when they should not be. STAR+PLUS is an expensive program that must be reserved for those beneficiaries that need it most. If this oversight ensures only those needing to be in STAR+PLUS are in the program, HB 1159 will save taxpayer resources and limit the amount of taxpayer dollars put toward unnecessary or inappropriate care. Support HB 1159.