ADA urges CMS to improve transparency of Medicaid managed care plans

Letter urges agency to exercise its ‘oversight abilities’ in reporting of medical loss ratios

The American Dental Association is asking the Centers for Medicare & Medicaid Services to improve the transparency of Medicaid managed care plans and how they report medical loss ratios

In a Feb. 22 letter to Natalia Chalmers, D.D.S., Ph.D., CMS chief dental officer, ADA President George R. Shepley, D.D.S., and Executive Director Raymond A. Cohlmia, D.D.S., urged the agency to exercise its oversight abilities as they pertain to Medicaid managed care plans and the reporting of medical loss ratios.

The ADA greatly supports transparency with public dollars, especially in Medicaid, and views MLR reporting as an important part of that transparency,” Drs. Shepley and Cohlmia said.

The letter noted that a brief from the Medicaid and CHIP Payment and Access Commission projected data from 2019 MLR requirements would be available in 2022. It also noted that a Health and Human Services’ Office of Inspector General September 2022 report reviewed 495 annual MLR reports from states to see if they contained the seven required data elements: claims costs; non-claims costs; quality-improvement expenses; premium revenue; taxes and fees; calculated MLR; and member months. It found that nearly half (49%) of the MLR reports submitted by managed care organizations in 28 states were incomplete and missing at least 1 of the 7 required data elements, thus allowing the reporting requirement to become optional.

The Office of Inspector General report made a number of recommendations that the ADA agrees with, however, it did not identify the managed care organizations that submitted the incomplete MLR reports or the states that did not address the reporting gaps,” Drs.  Shepley and Cohlmia wrote. “The ADA encourages the [Office of the Inspector General] to publish this information, which could further encourage the managed care organizations and states to meet the requirements.

Furthermore, the ADA encourages CMS to publish in a timely manner a state-by-state assessment of MCOs with the percentage of allocated Medicaid funding that is being spent on dental services and asks that CMS require each state Medicaid agency to monitor the specific dental loss ratio among their contractors.;

Because Medicaid is a critical access point for dental care to millions of enrollees, tracking the correct data is just as important to ensure Medicaid enrollees are getting the dental care they need going forward,” the letter concluded.

Follow all of the ADA’s advocacy issues at .

Recommended Content


© 2023 American Dental Association