SMMCAC Clinical Oversight and Administrative Simplification Subcommittee

Summary/Charge: Seeks to strengthen the oversight of utilization management practices to include prior authorization policies and processes used by manage care organizations (MCOs). Focuses on reducing Medicaid provider burden through administrative improvements in four areas: claims payments, eligibility information, provider enrollment processes and prior authorization submissions. Prior authorization discussions will focus on provider process issues and Health and Human Services Commission (HHSC) oversight of MCO prior authorization data. Also discusses specific Medicaid medical benefits as needed. Click here to view the full report.