In Annapolis, Maryland, the state’s largest Medicaid managed care organization has had its accreditation put on hold due to issues related to the credentialing and quality reviews of its healthcare providers, as reported by an official from the state health department. Managed care organizations are healthcare plans designed to oversee the provision of services through a network of contracted providers, with the aim of controlling costs.
Priority Partners, which serves approximately 350,000 Medicaid enrollees or around 24% of the state’s 1.5 million Medicaid participants, will be affected by this suspension. However, the halt will not impact the coverage benefits or the healthcare services available to current members. The state will cease new enrollments into Priority Partners effective March 17, as stated by Ryan Moran, the deputy secretary of healthcare financing and Medicaid director.
According to the health department, Priority Partners is currently the only managed care organization nationally to have its accreditation suspended. Efforts to obtain a statement from the organization have not yet been successful.
As of March 17, members enrolled in Priority Partners will have a 60-day period during which they can opt to transition to another managed care organization within Maryland. Moran emphasized that the state will inform existing members about their option to change plans if they choose to do so.
“We will be sending out communication to those members,” Moran expressed. “We will also update our website with relevant information.”
The suspension of Priority Partners’ accreditation was enacted by the National Committee for Quality Assurance (NCQA), an independent entity that evaluates and reports on healthcare plans’ performance metrics. “The Health Plan Accreditation for Priority Partners MCO has been suspended until they execute corrective measures and are re-assessed,” the NCQA communicated in an email. Details of the suspension remain confidential, and further actions are at the discretion of the Maryland Department of Health.
In Maryland, managed care organizations are obligated to keep and report their accreditation status with the NCQA, which Moran described as “the gold standard for evaluation in this field.” He stressed that the sanctions against Priority Partners are implemented to “ensure that Marylanders receive high-quality care statewide” and will persist until the accreditation suspension is lifted by the overseeing nonprofit body.
