Committee approves bill to require more public reporting and audits of Medicaid managed care

The committee unanimously adopted Substitute 1 and favorably recommended HB 566, legislation that would increase transparency and oversight of Medicaid managed‑care organizations (MCOs) in Utah.

Representative Katie Hall and analysts from the Paragon Institute outlined the bill’s aims: define the range of MCOs, require quarterly public reporting of claims and spending data, mandate independent financial and subcontractor audits, strengthen improper‑payment detection that considers how MCOs pay providers (not just state payments to MCOs), and add conflict‑of‑interest safeguards for actuaries who set Medicaid rates.

Stakeholders from managed‑care plans and health‑care coalitions said they supported transparency in principle and welcomed improvements in the draft, while urging refinement on report timing and materiality thresholds because much of the data is already provided to the agency in different formats.

Lawmakers said the proposed changes would give the Legislature, the public, and DHHS clearer visibility into how MCO dollars are used and could surface overpayments or misaligned incentives. The bill’s first substitute was adopted and the committee moved it forward with a favorable recommendation.