MACPAC Posts Meeting Transcript

The Medicaid and CHIP Payment and Access Commission met in Washington, D.C. earlier this month.  The issues on MACPAC’s agenda were:

  • state readiness to report mandatory core set measures
  • analysis of buprenorphine prescribing patterns among advanced practitioners in Medicaid
  • Medicaid’s statistical information system (T-MSIS)
  • Medicaid disproportionate share hospital payment (Medicaid DSH) allotments
  • Medicaid policies related to third-party liability
  • Medicaid and maternal health

A transcript of the MACPAC meeting is now available.  Find it here.

Verma Addresses Medicaid Issues

Yesterday, Centers for Medicare & Medicaid Services administrator Seema Verma spoke at a conference of the National Association of Medicaid Directors.

In addition to discussing a proposed regulation posted earlier in the day that would introduce changes in the regulation of state financing of their Medicaid programs, Verma also addressed:

  • Medicaid demonstration programs
  • Medicaid work requirements
  • a shift toward value-based payments
  • better coordination of care for the dually eligible (individuals serve by both Medicaid and Medicare)
  • enrollment issues
  • improvements in the efficiency of the federal Medicaid bureaucracy

Because private safety-net hospitals care for so many more Medicaid patients than the typical hospital, these issues are especially important to them.

Read Verma’s complete remarks here.

MACPAC Looks at Medicaid DSH

At a time when cuts in Medicaid disproportionate share hospital payments (Medicaid DSH) are still scheduled for the current fiscal year and some in Congress are calling for a new approach to allotting DSH funds among the states, the Medicaid and CHIP Payment and Access Commission has released its annual analysis of Medicaid DSH allotments to the states.

The report includes:

  • data about changes in the uninsured rate
  • demographic information about the uninsured
  • information about the cost of hospital uncompensated care
  • perspectives on hospital Medicaid shortfalls
  • a comparison of hospital uncompensated care costs when calculated using different methodologies
  • data about hospitals that provide “essential community services”
  • information about scheduled Medicaid DSH allotment reductions

All private safety-net hospitals receive Medicaid DSH payments and consider the program an essential tool for serving their communities.

MACPAC will issue a more complete report to Congress in March of 2020.

Learn more about how MACPAC views Medicaid DSH at a time when the program is scheduled to change – and when some want even more change – in the new MACPAC document “Required Analyses of Disproportionate Share Hospital (DSH) Allotments.”

 

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 devoted its Thursday morning discussion to integration of care for beneficiaries who are dually eligible for Medicaid and Medicare. Panelists Amber Christ, directing attorney at Justice in Aging; Griffin Myers, chief medical officer at Oak Street Health; and Michael Monson, senior vice president for Medicaid and complex care at Centene, presented beneficiary, provider, and health plan perspectives and a question and answer session followed.

After lunch, MACPAC staff briefed the Commission on challenges states face as they prepare for mandatory reporting of quality measures for children enrolled in Medicaid and the State Children’s Health Insurance Program (CHIP) and behavioral health measures for adults enrolled in Medicaid. Immediately following that session, the Commission reviewed a new MACPAC-commissioned study on the effects of federal legislation that provided new buprenorphine prescribing authority for nurse practitioners and physician assistants.

After a brief break, MACPAC staff updated the Commission on the status of the Transformed Medicaid Statistical Information System (T-MSIS). The final Thursday session discussed disproportionate share hospital (DSH) allotments as required in MACPAC’s annual March reports to Congress.

MACPAC’s Friday agenda opened with a session on improving Medicaid policies related to third-party liability: specifically, coordination of benefits with TRICARE, the health coverage program for active duty military and their dependents. There are close to 1 million Medicaid beneficiaries with TRICARE coverage but Medicaid’s ability to collect from TRICARE is limited. The final session of the October meeting addressed Medicaid and maternal health.

Supporting the discussion were the following briefing papers:

  1. State Readiness to Report Mandatory Core Set Measures
  2. Analysis of Buprenorphine Prescribing Patterns among Advanced Practitioners in Medicaid
  3. Update on Transformed Medicaid Statistical Information System (T-MSIS)
  4. Required Analyses of Disproportionate Share Hospital (DSH) Allotments
  5. Improving Medicaid Policies Related to Third-Party Liability
  6. Medicaid and Maternal Health: Work Plan and Further Discussion

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department  of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program.  MACPAC’s deliberations are especially important to private safety-net hospitals because those hospitals care for especially large numbers of Medicaid patients.  Find MACPAC’s web site here.

Safety-Net Hospitals Gird for Loss of Medicaid DSH Money

Safety-net hospitals and others will lose a significant portion of their Medicaid disproportionate share (Medicaid DSH) payments on November 22 unless Congress delays implementation of the cut in those payments that was mandated by the Affordable Care Act.

And hospitals that receive these payments are now preparing for the worst.

The Medicaid DSH cut was included in the 2010 health care reform law in anticipation of a great reduction in the number of uninsured people leaving hospitals providing much less uncompensated care and therefore not in need of as much DSH money.  The law’s reach has not proven to be as great as anticipated, however, and two developments since the law’s passage have put a damper on the expected rise in the number of insured Americans:  a court decision that made it optional for states to expand their Medicaid program and the repeal of the requirement that everyone purchase health insurance.

Four times Congress has voted to delay the Medicaid DSH cut because so many people remained uninsured.  Now, however, the most recent delay in implementation of the cut, via a provision in the continuing resolution currently funding the federal government, expires on November 21, and hospitals – many of them already with razor-thin margins – are preparing for the worst:  a major reduction of their federal Medicaid DSH money.

NASH has asked Congress to delay the implementation of Medicaid DSH cuts on numerous occasions, citing their potential impact on the ability of private-safety-net hospitals to serve their communities.  NASH most recently made this request in September, urging members of Congress to support the continuing bipartisan effort to delay the cut.

Learn more about the prospect of a major Medicaid DSH cut later this month, how it might affect safety-net hospitals – including the kinds of private safety-net hospitals represented by NASH – and what some hospitals are doing to prepare for the possibility in the Stateline article “Rural and Safety Net Hospitals Prepare for Cut in Federal Support.”

CMS Adopts Methodology for Medicaid DSH Cuts

Medicaid DSH money will be allocated among states based on a new methodology under a regulation adopted this week by the Centers for Medicare & Medicaid Services.

But it is not clear when that new methodology may actually be used.

Cuts in Medicaid disproportionate share hospital (Medicaid DSH) allotments to states were mandated by the Affordable Care Act based on the expectation that the law would greatly reduced the number of uninsured Americans.  While this has been the case, the decline in the number of uninsured has not been as great as expected.  For this reason, Congress has on several occasions delayed the required Medicaid DSH cut.

That cut is now scheduled to take effect next week, on October 1, but a continuing resolution to fund the federal government, passed last week by the House and now under consideration by the Senate, would delay that cut again – at least until November 22.

Private safety-net hospitals view Medicaid DSH as an essential tool in their effort to serve the uninsured and underinsured residents of the low-income communities in which they are located and strongly oppose any reductions in Medicaid DSH allocations to the states.  See a recent NASH policy statement on Medicaid DSH here.

Learn more about the new regulation governing the future allotments of Medicaid DSH money to the states and the prospects for Medicaid DSH allocation cuts being made anytime soon in the Healthcare Dive article “CMS finalizes Medicaid DSH cuts, but Congress could still delay” and see the regulation itself here.

NASH Reiterates Call for Delay of Medicaid DSH Cuts

NASH supports current, bipartisan efforts in Congress to delay Medicaid disproportionate share (Medicaid DSH) cuts required by the Affordable Care Act.

The National Alliance of Safety-Net Hospitals has long called for the delay or elimination of these Medicaid DSH cuts and reiterated this view in preparation for NASH Advocacy Day, which was held last week in Washington, D.C.  In NASH’s view, Medicaid DSH is a vital tool for helping private safety-net hospitals serve residents of the low-income communities in which those hospitals are located.

NASH reinforced this position in a new position statement that notes that

While many Americans have taken advantage of the Affordable Care Act to obtain health insurance, millions remain uninsured…and the past two years have seen the number of uninsured Americans rise, not fall…Consequently, any decline now in Medicaid DSH payments could lead to an increase in the provision of charity care, possibly forcing hospitals to reduce services limit community outreach, and even reduce staff.  Such measures could jeopardize access to care, not only for hospitals’ uninsured and low-income patients but also for their privately insured, Medicare, and Medicaid patients as well.

See the complete statement on delaying Medicaid DSH cuts here, on the NASH web site.

NASH Advocacy Day

Friday September 20, 2019 is NASH Advocacy Day in Washington, D.C.

Today, leaders of private safety-net hospitals have traveled to the nation’s capital from across the country for NASH Advocacy Day, during which members will meet with members of Congress and congressional and committee staff to discuss federal health care policy issues that affect the ability of private safety-net hospitals to serve their communities.

For the occasion, NASH has introduced three new policy position statements:  on the importance of delaying Medicaid disproportionate share (Medicaid DSH) cuts, surprise medical bills, and the new federal regulation governing so-called public charges.  See the new position papers here.

In addition, the National Alliance of Safety-Net Hospitals is presenting its “Champion for Health Care Award” to Representative Joe Kennedy III (D-MA) for “his tireless advocacy of access to care for his constituents, the residents of Massachusetts, and all Americans.”  See the news release announcing the award here.

Medicaid DSH Delay Advances in Energy and Commerce Committee

Medicaid disproportionate share cuts would be delayed for two years under a proposal advanced last week by the Health Subcommittee of the House Energy and Commerce Committee.

The Medicaid DSH cuts, mandated by the Affordable Care Act, have already been delayed three times by Congress and could be on their way to a fourth delay if the proposal advanced by the Health Subcommittee is endorsed by the Energy and Commerce Committee and works its way to the full House of Representatives, where such a proposal is thought to enjoy wide support.

The National Alliance of Safety-Net Hospitals has long endorsed the delay and even the repeal of cuts in Medicaid DSH payments, doing so most recently in a letter earlier this year to Senate Finance Committee chairman Charles Grassley in which it argues that those cuts would be especially harmful to private safety-net hospitals.

Learn more about the possibility of another delay of Medicaid DSH cuts in the HealthLeaders article “House Panel Advances Surprise Bill Package.”

 

Medicaid DSH Delay Wins Bipartisan Support

More than 300 members of the U.S. House have joined a letter to House leadership urging a delay in Affordable Care Act-mandated cuts in Medicaid disproportionate share payments (Medicaid DSH).

The bipartisan letter notes that hospitals that receive Medicaid DSH funds cannot absorb the loss of revenue such a cut would bring.  That cut, scheduled to begin in FY 2020, would amount to a $4 billion reduction in nation-wide Medicaid DSH spending in FY 2020 and an $8 billion reduction in each of FY 2021, FY 2022, FY 2023, FY 2024, and FY 2025.

NASH was actively involved in urging House members to join the letter.  If implemented, the Medicaid DSH cuts would be especially harmful to NASH members and all private safety-net hospitals – and to the low-income residents of the communities they serve.

See the bipartisan letter seeking a delay of Medicaid DSH cuts here.