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:
- State Readiness to Report Mandatory Core Set Measures
- Analysis of Buprenorphine Prescribing Patterns among Advanced Practitioners in Medicaid
- Update on Transformed Medicaid Statistical Information System (T-MSIS)
- Required Analyses of Disproportionate Share Hospital (DSH) Allotments
- Improving Medicaid Policies Related to Third-Party Liability
- 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 Pennsylvania safety-net hospitals because those hospitals care for especially large numbers of Medicaid patients. Find MACPAC’s web site here.
Specifically, they experienced:
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.
As reported by Kaiser Health News,
The Philadelphia Business Journal reports that since Hahnemann’s closing was announced during the summer, ER volume has risen 15 percent, admissions have risen 12 percent, and births have risen more than 50 percent at Thomas Jefferson University Hospital, a SNAP member. Meanwhile, SNAP member Pennsylvania Hospital has seen its ER visits rise nine percent, SNAP member Penn Presbyterian Medical Center has seen its ER volume increase five percent, and SNAP member the Hospital of the University of Pennsylvania has seen its ER volume rise five percent.
This area is served almost exclusively by Pennsylvania safety-net hospitals and recently suffered a major loss when one of those providers, Hahnemann University Hospital, closed its doors. 
Pennsylvania rates will rise an average of four percent for individual plans and 9.7 percent for small groups, the state Insurance Department has announced. All insurers that offered plans in 2019 will do so again in 2020 and the exchange will include a new insurer and increased choice in some of the state’s 67 counties. Beginning in 2020, residents of only six counties will have only a single insurer offering individual plans.
The Department of Human Services bulletin outlines the purpose of the new PDL, provides background information, and describes how the PDL was developed and will work. In addition, it lists the past Medical Assistance Bulletins rendered obsolete by the new bulletin and describes the prior authorization procedures that will be employed when the new program takes effect on January 1, 2020.
Included in this month’s edition are articles about:
Earlier this year, the Department of Human Services announced its intention to implement a preferred drug list in the state’s Medicaid program. That PDL would apply to both the fee for service and managed care Medicaid programs.