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

Insufficient
Communication and
Involvement of Outside
Groups
B-276078
486
reports are consistent and reconcilable and to identify reports that are
needed for the state to effectively monitor enrollment broker activities.
Finally, DtS initially had no system to determine whether problems
reported to DnS were recorded or addressed Although llis began keeping
an mco 'problem log" in January 1997 to capture and track the status of
problems and complaints reported to either miss, the enrollment broker, or
the Medi-Cal managed care ombudsman isis had not summarized or
systematically analyzed the information collected at the time of our
review.
HCrA, managed care plans, and advocates have long expressed concern
over a lack of effective state internal communication and timely
communication with and involvement of outside groups in planning and
decision-making. We found, for example, that until recently, uco policy
decisions often were not officially documented or disseminated to the
appropriate state staff. Dts has taken some steps to improve its internal
communications, such as requiring tco's polcy unit to provide written
documentation of all iito policy decisions to the chief of the Headquarters
Management Branch, Payment Systems Division, for review and
systematic dissemination.
wis has also increased its communication efforts with outside groups. To
provide a forum to discuss and address issues and concerns, the state has
convened or participates in several work groups. For example, the Policy
Workgroup was formed in January 1997 to improve the education and
enrollment process, such as by redesigning and translating the enrollment
materials. The group includes representatives from Ditis, iicFA, health plans,
advocacy groups, and Maximus. The state also convened in June 1997 a
Stakeholder Advisory Group to provide policy advice on and oversight of
program implementation in Los Angeles County. The group is composed of
advocates, provider representatives, DiS, Maximus, and the Los Angeles
commercial plan and local initiative- It plans to meet monthly.
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