MCOs are Agents of DMA!!!! Finally, Some Accountabilty!!!
Managed Care Organizations (MCOs) are agents of the Department of Health and Human Services (DHHS), Division of Medical Assistance (DMA). When an MCO manages the Medicaid system, the MCO, in essence, steps into the shoes of DMA.
As most of you know, I’ve been saying this for months. I was starting to worry my agency argument was falling on deaf ears. Then, lo, and behold, it turns out that an Administrative Law Judge agrees with me!!! Not only does he agree with me, but he drafts a beautiful, well-written, heavily-laden-with-legal-backing, butt-kicking, rock solid Order!!!! The Order makes me want to draft the following letter to MCOs:
You are agents of the State. Start acting like it.
But, read the Order yourself. What do you think?
Posted on April 12, 2013, in Alliance, Division of Medical Assistance, Federal Law, Health Care Providers and Services, Jurisdiction, Legal Analysis, Legislation, MCO, Medicaid, Medicaid Audits, Medicaid Contracts, NC DHHS, NCGS 108C-7, North Carolina, OAH, Prepayment Review, Reconsideration Reviews, Termination of Medicaid Contract and tagged Administrative Law Judge, Division of Medical Assistance, Health care provider, Managed care, Managed Care Organizations, Medicaid, Mental health, North Carolina, Tentative Notice of Overpayment, United States Department of Health and Human Services. Bookmark the permalink. 3 Comments.