GAO Review Of Managed MLTSS Finds Rate Setting Data Unreliable

A recent review by the federal Government Accountability Office (GAO) of payment structures for Medicaid managed long-term services and supports (MLTSS) in six states found that health plans could be underpaid or overpaid because states might have based rates on unreliable data. The structures include payment rates, incentive payments, and penalties. The GAO noted another confounding factor related to rate setting: although the Centers for Medicare & Medicaid Services (CMS) expects states’ MLTSS programs to enhance the provision of community-based care, CMS does not consistently require states to report on whether the payment structures are achieving MLTSS goals . . .