State And CMS Oversight Of The Medicaid Managed Care Credentialing Process (OEI-09-10-00270)

November 1, 2013 In November 2013, the federal Office of the Inspector General sampled six states and 234 managed care entities (MCEs) that included the three types of MCEs subject to federal credentialing regulations in order to determine the extent to which states complied with federal regulations. The OIG found that all six states’ credentialing policies and MCE contract provisions met federal standards. However, five of six States did not monitor MCEs’ compliance with the federal provider nondiscrimination contract provision that requires that MCEs not discriminate against providers that serve high-risk populations or that specialize in conditions requiring costly . . .