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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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 …