Agency explains RAC waiver after unsuccessful RFPs; members seek UPIC contract for alignment
Summary
Deputy commissioner said the state sought bids for a recovery audit contractor but received none and therefore sought a waiver; legislators urged better alignment with federal UPIC audits and requested any state-UPIC contract or business associate agreement for review.
Miss Shays Gleeson asked the department about a waiver extending the recovery audit contractor (RAC) exception through June 30, 2028, and how the UPIC fits into state auditing. Deputy Commissioner Veronica 'Judy' Cecil explained that as managed care has become the norm, RACs focused on fee-for-service work could not sustain a business model and the department received no bidders in two RFP cycles.
"We had no bidders, not a single 1," Cecil said, describing the procurement results and why the waiver was necessary. She added that most auditing of managed-care claims is performed by the MCOs. Legislators urged the department to share the state's contract or business associate agreement with the UPIC so they could better assess duplication and alignment; the department said it principally has a business associate agreement for HIPAA-related data sharing and that UPIC is a federal CMS contractor whose engagement is sometimes directed by CMS.
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