Ohio Medicaid Managed Care Medical Loss Ratio Audit
Learn how the AI-generated research projects were createdOverall Conclusion
While no remittances were required based on the identified errors, the audit revealed areas for improvement in Ohio's oversight and reporting practices to ensure compliance with federal requirements.
Source Document
Audit Scope
The audit covers the CY 2020 reporting period for Ohio Medicaid managed care plans, including six MCPs operating under both Medicaid Managed Care and Medicaid MyCare programs, with a focus on MLR reporting, remittance calculations, and oversight procedures.
Key Findings Summary
23 instances requiring correction in MLR remittance calculations, none of which affected the remittance threshold.
Identified noncompliance with federal and state requirements in MLR reporting and calculations.
AI-Assisted
AI Scope Summary
The audit aims to assess the accuracy and compliance of Ohio's Medicaid managed care plans' Medical Loss Ratio reporting for 2020, ensuring that the reported data supports the calculated MLRs and remittance obligations.
AI-Generated Insight
This audit highlights the importance of rigorous oversight and accurate reporting in Medicaid managed care to ensure financial integrity and compliance with federal standards. Implementing the recommended practices can enhance transparency, accountability, and program effectiveness.
Audit Objectives
To determine if managed care plans submitted annual MLR reports to Ohio as per federal requirements.
To verify if the MLR reporting and minimum MLR remittance calculations are supported by underlying data and documentation.
Audit Findings (2)
23 instances requiring correction in MLR remittance calculations, none of which affected the remittance threshold.
Identified noncompliance with federal and state requirements in MLR reporting and calculations.
Recommendations (10)
Request methodology details for expense allocation across lines of business.
Update instructions to exclude non-Medicaid expenses.
Review and correct risk corridor and MLR templates for consistency.
Require MCPs to submit risk corridor and MLR templates using the same runout period.
Monitor receipt of State Directed Payments and pass-through payments and reconcile with MLR reports.
Include SDP in numerator and reflect SDP revenue in denominator.
Update reporting templates to report only service-related costs and total reimbursements.
Guide plans on including healthcare quality activity expenses.
Require MCPs to collect data from third-party vendors.
Establish and maintain contracts with subcontractors.