State Medicaid Managed Care Advisory Committee (SMMCAC)Complaints, Appeals, and Fair Hearings Subcommittee

1. Call to order, roll call, and introductions. The meeting was convened by Dr. Karl Serrao, Chair. 2. HHS Office of the Ombudsman Managed Care Complaints Report, 2nd - 3rd Quarters 2023 2nd Quarter FY23 Substantiated Complaints 21 percent of all investigated cases were substantiated #1- Access to in-network specialist and facilities – (34) #2- Access to home health services - (21) #3- Access to prescriptions due to erroneous secondary incorrect insurance – (12) and; Access to Primary Care Physician – (12) Total contacts decreased 14 percent in the first two quarters of FY23 in comparison to the same time in FY22. Total contacts also decreased by 11 percent from the first to the second quarter of FY23. A review of case summaries of Medicaid eligibility and recertification related complaints showed an increase in complaints related to notices sent from the Social Security Administration (SSA) informing consumers that SSA would no longer pay their Medica