With more states delegating their programs of Medicaid managed long-term services and supports to managed care entities, state Medicaid programs and the federal government are not adequately overseeing the work of those managed care plans.

As a result, they sometimes fail to notice quality and access problems for beneficiaries, according to the U.S. Government Accountability Office.

When states delegate to managed care plans decisions about the amount and types of services that adults and children with physical, cognitive, and mental disabilities will receive, federal guidelines require states to monitor those decisions for appropriateness.  In too many cases, the GAO has concluded, states are not doing this job well.  To address this shortcoming, the GAO recommends that the Centers for Medicare & Medicaid Services develop a national strategy for overseeing MLTSS and “assess the nature and prevalence of MLTSS quality and access problems across the states.”  CMS rejected these recommendations.

Learn more about the challenges inherent in managed care plans administering Medicaid MLTSS in the GAO report Medicaid Long-Term Services and Supports:  Access and Quality Problems in Managed Care Demand Improved Oversight.…

The Centers for Medicare & Medicaid Services has issued a report on FY 2016 spending for Medicaid-covered long-term services and supports.  The highlights of the $167 billion in state and federal spending include:

• Home and community-based services have accounted for almost all Medicaid long-term services and supports growth in recent years.
• Home and community-based services spending increased 10 percent in FY 2016, greater than the five percent average annual growth from FY 2011 through 2015.
• Institutional spending remained close to the FY 2010 amount.
• Institutional service spending decreased two percent in FY 2016 following an average annual increase of 0.3 percent over the previous five years.
• Long-term services and supports provided through managed care continued to grow as states expanded their use of managed long-term services and supports delivery systems.
• Managed long-term services and supports spending amounted to $39 billion in FY 2016, a 24 percent increase from $32 billion in FY 2015.

Learn more about Medicaid spending and trends for long-term care and long-term services and supports in the new CMS report “Improving the Balance: The Evolution of Long Term Services and Supports, FY 1981-2014,” which can be found here.…

The Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP issues, met publicly in Washington, D.C. last week.

The following is MACPAC’s own summary of its two days of meetings.

The April 2018 meeting began with session on social determinants of health. Panelists Jocelyn Guyer of Manatt Health Solutions, Arlene Ash of the University of Massachusetts Medical School, and Kevin Moore of UnitedHealthcare Community & State discussed state approaches to financing social interventions through Medicaid. In its second morning session, the Commission reviewed a draft chapter of the June 2018 Report to Congress on Medicaid and CHIP on the adequacy of the care delivery system for substance use disorders (SUDs) with a special focus on opioid use disorders.

In the afternoon, the Commission discussed the Centers for Medicare & Medicaid Services (CMS) March 2018 proposed rule changing the process by which states verify that Medicaid fee-for-service provider payment is sufficient to ensure access to care and agreed to submit comments to the agency. The first day of the meeting concluded with a review of the draft June chapter describing the status of managed long-term services …

Members of the Medicaid and CHIP Payment and Access Commission met in Washington, D.C. last week to discuss a number of Medicaid and CHIP meetings.  The following is MACPAC’s summary of this meeting.

MACPAC’S March 2018 meeting began with a review of two draft chapters with recommendations that will be included in MACPAC’s June 2018 report, the first to improve operation of the Medicaid drug rebate program and the second to improve the clarity of substance use disorder (SUD) confidentiality regulations.

At the opening session the Commission reviewed a draft chapter on Medicaid drug policy and later voted to approve two recommendations presented at its December 2017 meeting to (1) close a loophole in current law that allows drug manufacturers to reduce rebates on certain brand drugs, and (2) give the Department of Health and Human Services new authority to take action on inappropriately classified drugs.

At the second morning session, the Commission reviewed a draft chapter on federal regulations governing confidentiality of SUD patient records that affect integration of behavioral and physical health services for Medicaid beneficiaries, later approving two recommendations to address the inconsistent application of these regulations. The morning wrapped up with a review of potential comments …

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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