MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. to discuss a variety of Medicaid and Children’s Health Insurance Program issues.

MACPAC, the non-partisan legislative branch agency that performs policy and data analysis and makes recommendations to Congress, the administration, and the states, addressed a number of issues during the meeting.  Among them it discussed Medicaid managed long-term services and supports (MLTSS) and voted to recommend that states be given the opportunity to seek permission to make Medicaid beneficiary enrollment in managed care plans mandatory through revisions of their state plan amendment rather than by seeking Medicaid waivers.

The commission also heard presentations on and discussed:

  • the integration of substance use disorder treatment with other Medicaid-covered services
  • residential substance abuse treatment and the exclusion of institutions for mental disease from treatment options
  • stakeholder experiences with MLTSS
  • Medicaid hospital payments
  • Medicaid managed care
  • the “Money Follows the Person” demonstration program
  • appeals for the dually eligible

Go here for a summary of the meeting and links to the presentations used for these subjects.

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ACA Improves Access to Surgical Services

The Affordable Care Act’s Medicaid expansion has improved access to surgical services for Medicaid patients.

Or so says a new study published in JAMA Surgery, which reports that

In this study of patients with 1 of 5 common surgical conditions, Medicaid expansion was associated with a 7.5–percentage point increase in insurance coverage at the time of hospital admission. The policy was also associated with patients obtaining care earlier in their disease course and with an increased probability of receiving optimal care for those conditions.

As a result, the study found,

The ACA’s Medicaid expansion was associated with increased insurance coverage and improved receipt of timely care for 5 common surgical conditions.

Learn more about the study, its findings, and the implications in the JAMA Surgery report “Association of the Affordable Care Act Medicaid Expansion With Access to and Quality of Care for Surgical Conditions,” which can be found here.…

Docs Not Scoring Performance Bonuses

Relatively few physicians will receive Medicare pay-for-performance bonuses under Medicare’s value-based modifier program in 2018.

The question now is whether this is because of uninspiring performance or indifference to the program.

Of the approximately 1.1 million clinicians who participate in Medicare, only two percent – 22,000 – will receive pay increases in 2018 based on their 2016 performance.  Those raises will range from 6.6 percent to 19.9 percent.

Most doctors will receive neither bonuses nor penalties.

And roughly 300,000 failed to submit the data required by the program.  In the past they would have been penalized for this failure but that penalty was eliminated for what is now the final year of the program.

Medicare now moves to a new merit-based incentive payment system – and this program, even though it is just beginning, has already been targeted for elimination by the Medicare Payment Advisory Commission.  MedPAC recommended eliminating the new program, known as MIPS, at its meeting earlier this month.

Learn more about physician performance under the value-based modifier program from this CMS fact sheet.…

Medicaid in the Spotlight

State-option work requirements.

A cap on federal spending.

New flexibility for states to address eligibility, benefits, and provider payments.

Rolling back the Affordable Care Act’s eligibility expansion.

Medicaid is under the policy microscope in Washington these days in ways it has not been for many years as the new administration continues to work to put its stamp on the federal government’s major program to provide health care to low-income Americans.

What are policy-makers considering and what are the potential implications of their efforts?  Learn more in the new Health Affairs blog article “Medicaid Program Under Siege,” which can be found here.…

Conflicts of Interest Mar HCBS

States’ efforts to provide home- and community-based services to elderly and disabled Medicaid beneficiaries who need assistance to continue living independently continue to be plagued with conflicts of interest that the Centers for Medicare & Medicaid Services is not adequately addressing.

Or so concludes a new study published by the U.S. Government Accountability Office.

According to the GAO,

…conflict of interest remain in regard to HCBS providers and managed care plans.  HCBS providers may have a financial interest in the outcome of needs assessments, which could lead to overstating needs and overprovision of services.  CMS has addressed risks associated with HCBS provider conflicts, such as by requiring states to establish standards for conducting certain needs assessments, but these requirements do not cover all types of HCBS programs.

To address this problem, the GAO recommends

…that all Medicaid HCBS programs have requirements for states to address both service providers’ and managed care plans’ potential for conflicts of interest in conducing assessment.

The study notes that the U.S. Department of Health and Human Services concurs with the GAO recommendations.

Learn more about the challenges facing the delivery of home and community-based services in the GAO report CMS Should Take Additional Steps to