Report of the Working Group on Medicaid Managed Care Organizations

This past month, the Medicaid Managed Care Organization (MCO) Working Group, convened in June by Speaker of the House, Robert A. DeLeo (D-Winthrop), and chaired by State Representative Jeffrey S√°nchez (D-Boston), House Chair of the Joint Committee on Health Care Financing, released their report on the status of Medicaid MCOs in Massachusetts.

The 13 member Working Group was charged with reviewing the delivery of Medicaid benefits by the MCOs, including cost-drivers and potential savings. This report covered many topics including behavioral health integration and alternative payment methodologies. There are many noteworthy pieces of this report, but one small section stood out. When discussing the challenges of rate setting (in general, not just for behavioral health), the relationship between antitrust laws and transparency presented a challenge:

“During Working Group discussions about provider contracts and pricing, the MCOs indicated that they could not discuss specific provider rates and contracts due to antitrust laws. Other stakeholders responded that price transparency would not violate antitrust laws. The system should not be paying providers radically different prices for the same services of comparable quality. There was some frustration from the Working Group because complete transparency is needed to fully understand the current issues and make policy recommendations.”

Click Here to read the full MCO Working Group Report

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