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Sen. John Marty has introduced legislation that would prohibit the state from enrolling any more Medicaid recipients into managed-care programs after March 1. Instead the Department of Human Services would be required to cover the individuals directly.

Marty introduces bill overhauling HMO oversight

John Marty

John Marty

Sen. John Marty has introduced legislation that would prohibit the state from enrolling any more Medicaid recipients into managed care programs after March 1. Instead the Department of Human Services would be required to cover the individuals directly.

Marty has persistently criticized the state’s HMOs — which receive roughly $3 billion each year to provide coverage for more than 500,000 individuals — for lacking accountability and transparency. The Roseville DFLer’s bill lays out five other proposed changes to HMO governance:

  • Competitive bidding: When the current health plan contracts expire, DHS would be required to hold a competitive bidding process for the 13-county metro area. Two managed-care organizations would then be picked to receive the state’s business.
  • Accounting standards: HMOs would be required to utilize Generally Accepted Accounting Principles. Currently most of the health plans adhere to accounting standards that are crafted for the insurance industry. Marty’s bill also explicitly defines the terms “medical costs” and “administrative costs.”
  • Oversight: The Legislative Auditor’s office would be required to “regularly” audit the health plans. No explicit time-frame is laid out.
  • Public records: HMOs would be subject to the state’s Data Practices Act, which determines what records are public.
  • Contracts: DHS would be required to cover only “reasonable and appropriate” costs accrued by the health plans. This language was spurred by a fiscal note issued last year in which the agency stated that any financial penalties handed down to the health plans would simply be added onto what they bill the state.

Marty’s bill does not have a House sponsor. Here’s a copy of the bill.

4 comments

  1. There can be a difference between what you and a health insurance company consider healthy. Some insurers will say that you have a health condition if you smoke, are overweight, are taking prescriptions, or had a medical condition in the past. If this describes you, you may want to search and read “Wise Health Insurance” on the web.

  2. We have a $6.2 billion deficit and cannot even find a house sponsor for a bill that adds much-needed accountability to a $3 billion poorly-audited HMO program? Is the leadership trying to run this state into the ground?

  3. Judging by another article in PIM about multiple bills on this subject, it will be complicated to judge which is best. The five points the article lists from Marty’s bill seem critical and I wonder how the others stack up in comparison. In fact, I think Marty specifies that the new 95,000 Medicaid enrollees not be handed over to the plans, something the article does not mention.

  4. Finally! Somebody interested in the waste the Corporate Giants (profit and non-profit) are forcing us into in the name of their personal greed. It has never made sense to insist an outside Admiinistrator should make all the decisions. HMOs must have greater accountability. 109Million profit on care for the poor paid for by low-middle income as well as higher income residents is unfair. It’s about time somebody started looking at why we’re broke and how to fix it, while looking at the systems, rather then insisting we have to make people starve or deny them any services. I’ve never been State supported but I know it’s an evil necessity of a world that doesn’t provide equally for citizens. We have much to fix to get everyone to work contributing, not needing so much assistance.

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