DMA contracted to Monitor all MCOs? Who Monitors DMA?

Last week at a preliminary injunction hearing, the Assistant Attorney General representing North Carolina Department of Health and Human Services (DHHS) argued that the Division of Medical Assistance has no control over Alliance Behavioral Health (Alliance) the Managed Care Organization (MCO), which manages the public mental health, intellectual/ developmental disability and substance abuse services for the citizens of Durham, Wake, Cumberland and Johnston counties.

I argued that SOME entity must be accountable.  Either DMA is the principle and accountable or the MCO is accountable and DMA provides no supervision.

Well, as you probably remember, in the January 2013 Medicaid audit conducted by the Office of the State Auditor, DMA was less than helpful in providing the contracts with agent-entities for the Auditor to review.

The Audit stated:

“Although contract payments represent a high percentage of its administrative budget, DMA was not able to provide a listing of contracts and the related expenditures in each SFY under review for this audit. DMA’s inability to provide this information is indicative of its inadequate oversight of contractual expenditures.”

I have yet to review the ACTUAL contract between DMA and any MCO. I would love to see one.  However,on DHHS’ website, I found a DRAFT contract between DMA and East Carolina Behavioral Health, (ECBH) the easterrn MCO.  So, please understand that the below contract excerpt is from what has been labeled on the website as a draft.  The below excerpt may or may not be similar to the actual signed and executed contract between DMA and ECBH.  Although, one has to wonder, if this draft contract ended up being completely different from the executed contract, why would this draft still be on DHHS’ website?

Regardless, this section of the draft contact states DMA’s control over ECBH.


According to this draft contract, it would seem that DMA must monitor and supervise the MCO.  If in fact, this section, or something similar, is also in the executed contract, and DMA is claiming zero control over the MCO (as seen last week by DMA’s attorney’s arguments), then we have found the accountability.  Who is watching DMA to ensure that DMA abides by the contract?

I sure would like to see the actual executed contract.  I’m willing to bet the answer to “who is accountable?” in the draft contract is similar to the answer to the question “who is accountable?” in the executed contract.


Posted on March 15, 2013, in Alliance, Division of Medical Assistance, Health Care Providers and Services, Legal Analysis, MCO, Medicaid, Medicaid Audits, Medicaid Contracts, Mental Health, NC DHHS, North Carolina, Office of State Auditor and tagged , , , , , , , . Bookmark the permalink. Leave a comment.

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