Casey speaks at the Capitol. Photo: Leigh Vogel/Getty Images
Sen. Bob Casey is pressing the Centers for Medicare and Medicaid Services for answers about its oversight of Medicaid managed care plans, pointing to denials of coverage for necessary care.
Why it matters: A Casey letter provided to Axios shows that scrutiny is expanding from the insurers who administer benefits to the oversight role of the administration.
- The inquiry comes after Senate Finance Chairman Ron Wyden and House Energy and Commerce Ranking Member Frank Pallone last week announced an investigation into MCOs' coverage denials.
What they're saying: "I am seeking information to ensure appropriate steps are taken to ensure MCOs are not putting their bottom line ahead of the interests of patients seeking care," Casey writes in the letter, dated Tuesday, to CMS administrator Chiquita Brooks-LaSure.
- The catalyst is an HHS inspector general report from July that found that Medicaid managed care organizations the watchdog reviewed denied coverage for one out of every eight prior authorization requests on average.
- In some cases the rate was much higher: 12 of the 115 MCOs in the review had denial rates above 25 percent, the IG found.
What's next: Casey asked CMS a series of questions about its plans for stepping up oversight of MCOs and asked for answers by Nov. 16.
