Sept. 13 is the deadline Sens. Chuck Grassley (R-IA) and Bob Casey (D-PA) on Friday gave to Centers for Medicare & Medicaid Administrator Seema Verma and the directors of the eight external quality review organizations that audit Medicaid managed care organizations to answer questions about access and quality of states’ long-term services and supports programs.

Grassley is the chairman of the Senate Finance Committee, of which Casey is a member. Additionally, Casey is the ranking member of the Senate Special Committee on Aging.

Increasingly, the senators noted, older adults are receiving LTSS from MCOs through home- and community-based services. The number of states implementing managed care for beneficiaries needing LTSS increased from eight in 2004 to 27 in 2017, they said.

“In order to ensure these changes do not cause disruptions for vulnerable people who tend to have significant health care needs, it is incumbent upon CMS and states to ensure adequate oversight,” Grassley and Casey wrote to Verma, later adding: “Managed care has the potential to improve outcomes and save money by streamlining health care services, and in many cases that has been documented. However, the Medicaid managed care program must be responsive to the unique needs of those beneficiaries with disabilities who depend upon MLTSS.”

The senators had four questions for Verma and eight questions for the EQRO directors. All pertained to the use and monitoring of LTSS programs, especially in light of 2013 guidance from CMS related to Section 1115 and 1915(b) waivers. Additionally, Verma was asked about CMS’ implementation of reforms outlined in a 2017 report from the Government Accountability Office.