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

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COMMENTS ON THE DRAFT REPORT
We solicited and received comments on the draft report from the Health <strong>Care</strong> Financing
Administration, the Acting Assistant Secretary for Health (ASH), and the Assistant
Secretary for Planning and Evaluation (ASPE). The ASPE concurred without elaboration.
The HCFA and ASH comments appear in full in appendix B. Below we summarize them
and offer our response in italics.
The HCFA concurred with our first two recommendations. It reinforced the importance
of using existing mechanisms to help States learn from one another as they move from
fee-for-service to managed care arrangements. It also agreed with the importance of
reviewing and revising HCFA monitoring protocols so that they are sufficiently sensitive
to the organizational challenges associated with expanded managed care.
With respect to our third recommendation calling for the State <strong>Medicaid</strong> agencies to
scrutinize possible adverse effects of managed care expansion on the performance of
established fee-for-service functions, HCFA offered a partial concurrence. It noted that
actions taken in response to the first two recommendations could alleviate the need for
such scrutiny and that HCFA, as our report indicates, is already doing a good deal to
monitor possible adverse effects.
In line with the above comment, HCFA suggested that our reference to "danger signs' in
the fee-for-service sector be changed to "concerns." It also suggested that the States
discussed in the report be given the opportunity to comment on it.
We considered HCFA's suggestion on characterizing the possible problems in the fee-forservice
sector as 'concerns' rather than 'danger signs. ' We decided to retain the latter
term because it more accurately reflected what we heard and observed in the study States.
At the same time, as we note in the report, we present the danger signs as early alerts
that could emerge as significant problems if not adequately addressed.
Concerning HCFA's other comment about obtaining feedbackfrom the States reviewed, we
have received considerable comment from them during the course offraming ourfindings
and recommendations. We are distributing the report widely among the States, and, as is
our custom, will include with it a userfeedbackform invitingfirther comment.
Finally, the Acting Assistant Secretary of Health did not comment on specific findings or
recommendations in the report, but did offer four suggestions intended to enhance the
transition process to <strong>Medicaid</strong> managed care. They are helpful suggestions that warrant
consideration by the States and HCFA. They concern the involvement of the State health
departments in the managed care process, the need for broad stakeholder involvement in
the process, the need to strengthen the integration of public health concerns into the
change process, and the importance of strengthening compliance, monitoring, and
evaluation at the State level.
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