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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 Medicaid and CHIP Payment and Access Commission kicked off its December meeting with highlights from its forthcoming issue of MACStats: Medicaid and CHIP Data Book, due out December 18, 2019. MACStats brings together statistics on Medicaid and State Children’s Health Insurance Program (CHIP) enrollment and spending, federal matching rates, eligibility levels, and access to care measures, which come from multiple sources.

Later the Commission discussed a proposed rule that the Centers for Medicare & Medicaid Services issued in November, which—among other changes—would increase federal oversight of Medicaid supplemental payments. The final morning session addressed payment error rates in Medicaid, with a briefing on the annual Department of Health and Human Services Agency Financial Report (AFR). Fiscal year 2019 was the first time that the AFR incorporated eligibility errors since the Patient Protection and Affordable Care Act’s Medicaid eligibility and enrollment changes took effect in 2014.

After lunch, MACPAC staff summarized themes from expert roundtables convened in November, one to explore Medicaid policy on high-cost specialty drugs and another on the need for more actionable Section 1115 demonstration evaluations. Then, the Commission turned its attention to Medicaid estate recovery policies. The final session of the day looked at issues associated with reforming the current Medicaid financing structure to better respond to economic downturns.

At Friday’s opening session, the Commission considered policy options to increase participation in Medicare Savings Programs, which provide Medicare cost-sharing assistance to beneficiaries who are dually eligible for Medicaid and Medicare. Afterward, the Commission continued its examination of care integration for dually eligible beneficiaries, this time focusing on policy options to reduce barriers to integrated care. The Commission then switched gears for a briefing on a new MACPAC analysis of Medicaid’s role in financing maternity care. The December meeting concluded with a review of the draft chapter for the Commission’s March report to Congress analyzing disproportionate share hospital (DSH) payments.

Supporting the discussion were the following briefing papers:

  1. MACStats: Medicaid and CHIP Data Book
  2. Review of Proposed Rule on Supplemental Payments and Financing
  3. Review of PERM Findings
  4. Themes from Expert Roundtable on Medicaid Policy on High-Cost Drugs
  5. Improving the Quality and Timeliness of Section 1115 Demonstration Evaluations: Themes from Expert Roundtable
  6. Medicaid Estate Recovery Policies
  7. Policy and Design Issues for a Countercyclical Federal Medicaid Assistance Percentage
  8. Medicare Savings Programs Policy Options
  9. Barriers to Integrated Care for Dually Eligible Beneficiaries
  10. Medicaid’s Role in Financing Maternity Care
  11. Review of Draft Chapter on Statutorily Required Analyses of Disproportionate Share Hospital Payment

Because they serve so many Medicaid and CHIP patients – more than the typical hospital – MACPAC’s deliberations are especially important to private safety-net hospitals.

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.  Find its web site here.

Medicaid Supplemental Payments Set to Evolve

New health care delivery and reimbursement systems and new federal regulations will result in changes in how states deploy their Medicaid resources through supplemental payments in the coming years.

A new Commonwealth Fund report describes the kinds of supplemental Medicaid payments states currently make to hospitals – such as disproportionate share and upper payment limit payments – and notes the differing degree to which individual states use such supplemental payments.

financeIt also describes how those supplemental payments may be restructured in the coming years to foster greater use of value-based purchasing and to reward achieving state-created quality goals through new delivery and reimbursement systems such as accountable care organizations, bundled payments, shared savings program, capitated arrangements, and shared risk.

Such changes have potentially serious implications for private safety-net hospitals.

Learn more about what the future may have in store for Medicaid supplemental payments in the Commonwealth Fund report Integrating Medicaid Supplemental Payments into Value-Based Purchasing.

GAO Looks at Supplemental Medicaid Payments

Following up its own 2012 report that identified more than 500 hospitals receiving supplemental Medicaid payments that resulted in Medicaid payment surpluses, the U.S. Government Accountability Office has taken a broader look at supplemental payments state Medicaid programs make to hospitals and how those payments are used.

gaoIn a limited study of hospitals in four states, GAO found that some hospitals used supplemental payments for purposes other than serving Medicaid patients and the uninsured – purposes such as ordinary operations, capital purchases, a poison control center, even a helicopter. GAO also found that hospitals were more likely to receive such payments if local funding was used to draw down federal Medicaid matching funds. In some places, hospitals with local governments willing to finance the payments were more likely to receive them than hospitals located in places without such local support.

The GAO recommended that the Centers for Medicare & Medicaid Services take stronger steps to ensure that supplemental Medicaid payments are linked to the provision of Medicaid services and that CMS not permit states to make those payments contingent on local financing.

Learn more about why the GAO looked at supplemental Medicaid payments, what it learned, and what it recommended in the report Federal Guidance Needed to Address Concerns About Distribution of Supplemental Payments.

 

GAO: More Information Needed About Supplemental Medicaid Payments

More data is needed about the supplemental Medicaid payments states make to hospitals and how those payments are financed, according to a new report from the U.S. Government Accountability Office (GAO).

According to the GAO, states are increasingly funding non-disproportionate share gao(Medicaid DSH) supplemental Medicaid payments to hospitals with funds from local governments and providers that are then matched by the federal government. In some states those supplemental payments, with the help of federal Medicaid matching funds, result in hospitals receiving reimbursement from Medicaid that exceeds the cost of the care they provide to their Medicaid patients.

In response to this concern, the GAO has urged the Centers for Medicare & Medicaid Services (CMS) to collect more and better data about how states finance their Medicaid programs and to do more to ensure that accuracy of that data. For its part, CMS maintains that its current efforts are adequate.

Learn more about this issue from the GAO report Improving Transparency and Accountability of Supplemental Payments and State Financing Methods, which can be found here.