Archive for Medicaid and CHIP Payment and Access Commission

 

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The Commission wrapped up its work on the June 2019 Report to Congress on Medicaid and CHIP at the April meeting, with sessions reviewing four of the report’s five draft chapters on Thursday morning, and votes on potential recommendations later in the afternoon.

First on Thursday’s agenda was a draft June chapter on Medicaid prescription drug policy, which contained draft recommendations to provide states with a grace period to determine Medicaid drug coverage and raise the cap on rebates. The Commission then revisited hospital payment policy, with a draft chapter and recommendation on how to treat third-party payment in the definition of Medicaid shortfall when determining disproportionate share hospital payments. Next, commissioners considered two recommendations proposed as part of a June chapter on improving the effectiveness of Medicaid program integrity. The final morning session addressed the Commission’s proposed recommendation on therapeutic foster care.

The Commission returned from lunch for two presentations discussing preliminary findings of forthcoming congressionally mandated reports. The first afternoon session presented initial findings from a MACPAC review of state Medicaid utilization

MACPAC Makes DSH, UPL Recommendations

Changes could come in Medicaid DSH and UPL payments if new MACPAC recommendations are adopted.

Last week the Medicaid and CHIP Payment and Access Commission released its annual report to Congress, with most of the report focusing on its analysis and recommendations for policy updates involving Medicaid disproportionate share hospital payments (Medicaid DSH) and Medicaid upper payment limit payments (UPL payments).

With Affordable Care Act-mandated cuts in Medicaid DSH payments scheduled to start in FY 2020 – this coming October – MACPAC recommended that these cuts be reduced and phased in over a longer period of time “…to give states and hospitals more time to respond to the cuts…”

MACPAC also recommended that Congress and the administration revise the current methodology for distributing Medicaid DSH money to the states to “…provide a stronger link between the distribution of those allotments and measures of hospital uncompensated care…”

The commission also addressed UPL payments, expressing concern about “…the discrepancy between reporting by states to show that they are complying with the UPL and the spending data they report to claim federal matching funds” and recommending “…instituting better data and process controls to ensure that state reporting on compliance with UPL lines up …

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

MACPAC looked ahead to its June 2019 report to Congress on the initial day of the March 2019 Commission meeting. In the morning, sessions focused on potential recommendations to create a grace period for states to determine coverage policies for outpatient prescription drugs and removing or raising the rebate cap; a uniform definition of therapeutic foster care; and treatment of third-party payment when determining hospitals’ Medicaid shortfall for disproportionate share hospital payments.

In the afternoon, the Commission turned its attention to Puerto Rico’s Medicaid program, with a new analysis on Puerto Rico’s Medicaid enrollment, spending, available financing, and implications for the future. The Commission also considered potential June recommendations focusing on improving performance and return on investment for state program integrity activities.

Several other important topics were also on the March agenda, including a session on Medicaid coverage of recovery support services for beneficiaries with substance use disorders (SUDs) in the afternoon. On the meeting’s second day, the Commission reviewed a draft letter to the Secretary of the U.S. Department of Health and Human

Docs Still Less Likely to Treat Medicaid Patients

Medicaid patients continue to be last in line when it comes to finding doctors willing to serve them.

At least that’s the conclusion drawn in a new analysis prepared by the Medicaid and CHIP Payment and Access Commission.

According to a presentation delivered at a MACPAC meeting last week:

  • Doctors are less likely to accept new Medicaid patients (70.8 percent) than they are patients insured by Medicare (85.3 percent) or private insurers (90 percent), with a much greater differential in acceptance rates among specialists and psychiatrists.
  • Pediatricians, general surgeons, and ob/gyns have a higher acceptance rate of Medicaid patients than physicians as a whole.
  • Physicians in states with high managed care penetration rates are less likely (66.7 percent) to accept Medicaid patients than physicians in states with low managed care penetration (78.5 percent).
  • There is no meaningful differential in acceptance rates among physicians in Medicaid expansion states and states that did not expand their Medicaid programs under the Affordable Care Act.
  • Physician acceptance rates have not changed since adoption of the Affordable Care Act in either Medicaid expansion nor non-Medicaid expansion states.
  • The higher the ratio of Medicaid-to-Medicare physician payments in an individual state, the more likely that physicians in