Maryland's largest managed care organization for Medicaid enrollees has suspended certifications due to concerns about provider credentials and quality reviews, a state health department official said Friday.
ANNAPOLIS, Md. (AP) — Maryland's largest managed care organization for Medicaid enrollees has suspended certifications due to concerns about provider certification and quality reviews, state health officials said Friday.
A managed care organization is a healthcare company or plan that aims to manage medical expenses by overseeing the delivery of care through a network of contract providers.
Priority Partners has around 350,000 enrollees for Medicaid, or about 24% of Maryland's roughly 1.5 million enrollees in a government-funded health insurance program for low-income people, according to the Health Department.
The suspension will not affect current members of the plan's compensation benefits or access to care, but the state has suspended new registrations with priority partners as of March 17, said Ryan Moran, deputy director of medical finance and Medicaid director for the state's health department.
According to the Health Department, the Priority Partner is the only Medicaid managed care organization in the country that has been suspended. The company did not immediately return a call seeking comment.
Starting March 17, Moran said, anyone registered as a preferred partner will have a 60-day window to switch to another managed care organization in the state. He also said the state would inform current enrollees of their right to change plans if they wish.
“We will follow up on communications with those members,” Moran told The Associated Press on Friday. “We'll post information on our website again.”
The certification of priority partners has been suspended by the National Quality Assurance Committee, an independent nonprofit organization that measures and reports on plan performance.
“NCQA has suspended certification of the health plan for its Priority Partner MCO until it has implemented corrective action and is reinstated,” the nonprofit wrote in an email. “Details of the suspension cannot be revealed. Further action is at the discretion of the Maryland Department of Health.”
Maryland managed care organizations must maintain and report accreditation with the NCQA, which Moran calls “the gold standard for assessment in this respect.”
He said sanctions against priority partners “ensure that Maryland, the state, receives the highest quality of care,” and will remain in effect until the nonprofit oversight board lifts the suspension.
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