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

B-276078
484
standards can provide incentives for the enrollment broker to provide the
services required and penalties for nonperformance.
DIlS' contract with Maximus, the current enrollment broker, contained
several performance standards; however, few were tied to payment. For
example, although call-center staff were required to answer phones within
three rings and process enrollment forms within 2 days, there was no
penalty for noncompliance. More importantly, no performance standards
that were tied to payment related to potential quality indicators, such as
the rate of automatic assignment, beneficiary satisfaction with the
education and enrollment process, or the rate of beneficiary
disenrollnment. "California is planning to amend Maximus' contract to
include additional performance standards and to increase the number of
standards that are tied to payment, which should help strengthen the
contract and make it more enforceable.
HCO Program Poorly According to ncFA, many of the problems with the state's process for
Monitored educating and enrolling beneficiaries were the result of inadequate
monitoring of the ueco program. Until recently, ilis did not conduct on-site
monitoring of enrollment broker activities nor did it have staff with the
expertise to monitor the broker's automated systems. In addition, tico's
management information and reports were not adequate to effectively
monitor the program.
According to DoI is, regular, on-site monitoring of Benova was difficult since
Benova's operations were about 80 miles from lis headquarters in
Sacramento. Without on-site monitoring, however, Dits could not
guarantee that critical broker responsibilities, such as the mailing of
enrollment packets, were carried out- For example, it was not until
enrollment broker operations were transitioning to Maximus that mis
found that thousands of beneficiary enrollment packets had not been sent
from a Benova mail facility. To help ensure this does not recur, as a
condition of its contract, Maximus operations are located in or near
Sacramento. mis also has dedicated five full-time Payment Systems
Division staff, four of whom have autontated systems expertise, to conduct
on-site monitoring at Maximus' various locations. To help ensure Maximus
complies with the terms of its contract, outs staff observe the broker's
operations and test the automated systems. Staff also observe mad facility
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