The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its “March 2013 Report to the Congress on Medicaid and CHIP,” including both policy recommendations and data updates. The policy recommendations address implementation of ACA provisions designed to expand health insurance coverage. First, MACPAC recommends that Congress create a statutory option for states to implement 12-month continuous eligibility for children enrolled in CHIP and adults enrolled in Medicaid, in conformance with policies in effect for children in Medicaid (the report notes that the option will otherwise be removed under new income-counting eligibility standards). Second, MACPAC recommends that Congress permanently fund Transitional Medical Assistance (TMA), while allowing states to opt out of the program if they expand to the new adult group added by the ACA. The report also includes a discussion of various policy issues involving the dually eligible Medicare and Medicaid population, and it provides an update to its MACStats data supplement.
The Medicaid and CHIP Payment and Access Commission (MACPAC) is meeting November 15, 2012 to discuss a variety of Medicaid policy issues, including: health care delivery system issues for Medicaid beneficiaries with disabilities; Medicaid primary care physician payments; Medicaid/CHIP Exchange interactions; the Medicaid/Medicare dually eligible population; and state Medicaid payment policies for Medicare cost sharing.
The Medicaid and CHIP Payment and Access Commission (MACPAC) has issued its 2012 “Report to the Congress on Medicaid and CHIP,” which provides Congress with data and recommendations regarding quality of care, costs, and quality in the Medicaid and CHIP program. MACPAC specifically recommends that the Secretary and the states accelerate development of program innovations that support high-quality, cost-effective care for persons with disabilities, particularly those with Medicaid-only coverage, with priority given to innovations that promote coordination of physical, behavioral, and community support services and the development of payment approaches that foster cost-effective service delivery. The Secretary and states also should update and improve quality assessment for Medicaid enrollees with disabilities. In addition, MACPAC makes a series of recommendations to increase the efficiency of program integrity efforts while preventing an undue burden from being placed on states and providers. To enhance the states’ abilities to detect and deter fraud and abuse, the Secretary is encouraged to, among other things, promote effective analytic tools for detecting and deterring fraud and abuse, improve dissemination of best practices in program integrity; enhance program integrity training programs (including additional courses that address program integrity in managed care).
The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its June 2011 “Report to the Congress: The Evolution of Managed Care in Medicaid.” The report describes what is known about the current use of managed care in Medicaid, including information on the populations enrolled; Medicaid managed care plan arrangements; payment policy; access and quality; and program accountability, integrity, and data. The report also includes updated “MACStats,” featuring national and state-level information on Medicaid enrollees, spending, and the use of managed care.
On May 6, 2011, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule to create a standardized, transparent process for states to follow when they set Medicaid payment rates. Under the Social Security Act, state plans must ensure that payment rates for Medicaid services “are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that services are available to Medicaid eligible individuals to the extent that they are available to the general population in the geographic area.” CMS points out that states currently do not have guidance on how to determine compliance with the statutory access requirements, an “issue that has come to light recently, both in litigation and in our review of proposed Medicaid State plan amendments (SPAs) that would reduce provider payment rates.” CMS therefore is proposing to clarify the definition of access to care and services and provide standard data elements and measures that states must submit to CMS to demonstrate that payment rates are sufficient to provide access to covered Medicaid services. If a state proposes provider rate reductions or restructuring that could result in access issues, the state would be required to conduct an “access review” using a three-part framework recommended by the Medicaid and CHIP Payment and Access Commission (MACPAC). The elements of the MACPAC framework that must be addressed are: the extent to which enrollee needs are met, the availability of care and providers, and changes in beneficiary utilization of covered services. The review also would include a comparison of Medicaid payment rates to customary charges and Medicare, commercial payments, or provider cost. In addition, the proposed rule would require that states develop monitoring procedures after implementing provider rate reductions or restructuring rates in ways that may negatively impact access to care. The rule also would recognize, as states have requested, electronic publication as an optional means of communicating to the public information about SPAs with proposed rate-setting policy changes. CMS will accept comments on the rule until July 5, 2011.
On March 15, 2011, the Medicaid and CHIP Payment and Access Commission (MACPAC) released its first Report to the Congress on Medicaid and CHIP. The report: provides an overview on the Medicaid and CHIP programs, their roles in the U.S. health care system, and the key policy and data issues to be addressed; describes the analytic framework that the Commission will use in future work on policy issues outlined in its statutory charge on access to care and Medicaid payment policy; examines factors for assessing access to care, evaluating payment policies, and identifying key data sources for policy analysis and program accountability; and introduces Medicaid and CHIP Program Statistics, MACStats, a compilation of national and state-specific program information on eligibility, benefits, and Medicaid spending.