Maryland’s largest provider for Medicaid enrollees loses accreditation

A managed care organization is a health care company or plan that aims to control health care costs by supervising the delivery of care through a network of contracted providers.

Priority Partners has about 350,000 enrollees in Medicaid, or about 24% of Maryland’s roughly 1.5 million enrollees in the government-funded health insurance program for low-income people, according to the health department.

The suspension does not affect coverage benefits or access to care for current members in the plan, but the state is suspending any new enrollment into Priority Partners as of March 17, said Ryan Moran, deputy secretary of health care financing and Medicaid director for the state health department.

Priority Partners is the only Medicaid managed care organization in the nation with an accreditation suspended, according to the health department.

Starting March 17, enrollees will have a 60-day window to switch to another managed care organization in the state, Moran said. He also said the state will notify current enrollees of their right to change plans if they want.

“We will be following up with communication to those members for those impacted by this,” Moran said in an interview with The Associated Press on Friday. “We will also be posting information on our website.”

The department said Priority Partners’ accreditation was suspended by the National Committee for Quality Assurance, which is an independent nonprofit that measures and reports on a plan’s performance.

Managed care organizations in Maryland are required to maintain and report on their accreditation with NCQA.

The sanctions will remain in effect until the suspension is lifted by the NCQA, Moran said, which he called “the gold standard of evaluation in this regard.”

“I will just note that the department takes the work of NCQA — because it’s so ingrained in terms of quality and program integrity — very seriously, and today’s response in terms of the department’s actions related to Priority’s suspension of their accreditation status is in the interest to ensure that Marylanders across the state receive top-quality care,” Moran said.

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