Medicaid Managed Care - U.S. Senate Special Committee on Aging

B-27607S
483
as the cause of initial enrollment problems experienced by beneficiaries in
t e
Sacramento's GMC program.
These and other management weaknesses-such as insufficient contract
performance requirements for enrollment brokera, inadequate monitoring
of the um program, and poor communication with and involvement of
outside groups-contributed to the problems the state encountered in
implementing its two-plan model." Benova and Maximus also cited
reasons that made it difficult for them to perform as efficiently as possible.
The state has taken a number of long-needed actions aimed at improving
various aspects of the liac program. However, the effect of some of these
actions remains to be seen.
Federal guidance on designing and implementing a mandatory managed
care program, especially when education and enrollment functions are
contracted to an enrollment broker, may have assisted the state in
improving its program implementation in its earlier stages. Although HcFA
is currently developing such guidance, uicrA's oversight of California's
program has consisted primarily of approving the waiver application and
conducting preimplementation reviews of each county prior to full
implementation.a
Contracts Insufficient to Dius' contract with Benova, the former enrollment broker, contained no
Hold Enrollment Brokers specific performance standards. Performance standards should make clear
Accountable the level of service expected of the broker and enable a state to gauge the
sufficiency of the broker's operations. When tied to payment, performance
mSpe. 1y, U. MUe Ant d th U b -tea vl p- chat' G aydee tO
e-utntte maeeiab an lteo tel ene, eotteht td W tion tttleedin td aW ca -eete ahta
ntent~theed ala th. -oltn etolk B 5 or.t f agltttde an betpten of etottens ith
p.nded n b-clen.add. al te or attI t tetne. MtltV Of PettY Ri m,
ttCeeice la Ite tptaitn A C- SLty of Maged C t Celifon- (W.hlgto, ia
.C_ itshetotkPdloy Iteath, Foe.. WIy Isi). -
t'oA-.g to taDIM utetnt bh. ls pld the pot. Forteat year ly-6, the MediCal
Mettaad Can DWlWnot relltetad -ttrtdlttin 125 SalT to otent ito otatd -tt pnote
Itoteve. the Sat lnIatone Pyp-td notrta lo- thee t.o-tthtt of th-e toateoto The
PasoetytL SYetto, Doi-n Icomldy eineg on ktdiontI 26 Sa pErtr c -oe the ROD peOtoPe
ofrotaL. sY the they ned to nete -ton mtattg bnt th.- beet ottae to tinte titetoee
needed t prepareyed tteli&ktteatit
"HCFA.app-t of Cailtleni aal -oe r et Zin tpt en fa1 idttig e-eeie
tha toll pteete of the t et0 .atd e not tttneto i a o tttY IICFA hbd
nnedit _nooet be=lie =ree quaiy of tat ted tdem' rtaea olotn 'Tetetnenn
to all enee tea=,taedllty atittd wai spedt ntig ti te notitaitt elt tateed
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