Maryland Withholds Payments to Several HMOs That Fail to Meet Medicaid Quality Standards

The eight managed care companies participating in HealthChoice, Maryland's Medicaid managed care program, have shown "strong improvement" on quality of care measures, but still need to improve on prenatal and diabetes care measures, according to an annual state Department of Health and Mental Hygiene audit released July 31. The Baltimore Sun reports that the state will withhold $237,000 from four MCOs -- Americaid, Maryland Physicians Care, Priority Partners and United HealthCare -- that failed to meet this year's prenatal and diabetes care standards. In addition, FreeState Health Plan, which dropped out of HealthChoice this year, and as such, is not subject to deductions from future payments, must repay the state $34,577. According to the audit, all clinical quality scores and most administrative scores were up this year, compared to previous years (Salganik, Baltimore Sun, 8/1). In addition to diabetes and prenatal care, clinical-focus areas included immunizations, pediatric asthma, somantic mental health and well-child exams (DHMH release, 7/31). MCOs that improve their scores can earn back the withholdings: This year, the MCOs earned $5,200 of the $233,000 withheld last year. Debbie Chang, Maryland deputy health secretary, said, "We have been successful in working with the health plans to improve performance. The aggregate scores have improved substantially." HealthChoice provides care for more than 400,000 Maryland Medicaid beneficiaries, mostly children (Baltimore Sun, 8/1).