Medicaid and CHIP Payment and Access Commission Archives - Page 2 of 4

Docs Still Less Likely to Treat Medicaid Patients

Medicaid patients continue to be last in line when it comes to finding doctors willing to serve them.

At least that’s the conclusion drawn in a new analysis prepared by the Medicaid and CHIP Payment and Access Commission.

According to a presentation delivered at a MACPAC meeting last week:

Doctors are less likely to accept new Medicaid patients (70.8 percent) than they are patients insured by Medicare (85.3 percent) or private insurers (90 percent), with a much greater differential in acceptance rates among specialists and psychiatrists.
Pediatricians, general surgeons, and ob/gyns have a higher acceptance rate of Medicaid patients than physicians as a whole.
Physicians in states with high managed care penetration rates are less likely (66.7 percent) to accept Medicaid patients than physicians in states with low managed care penetration (78.5 percent).
There is no meaningful differential in acceptance rates among physicians in Medicaid expansion states and states that did not expand their Medicaid programs under the Affordable Care Act.
Physician acceptance rates have not changed since adoption of the Affordable Care Act in either Medicaid expansion nor non-Medicaid expansion states.
The higher the ratio of Medicaid-to-Medicare physician payments in an individual state, the more likely that physicians in those states will accept Medicaid patients. The difference is especially great among general practitioners and ob/gyns.

Learn more from the MACPAC presentation “Physician Acceptance of New Medicaid Patients.”

PA Safety Net Admin2019-01-31T06:00:14+00:00January 31st, 2019|Uncategorized|Comments Off

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.

Hospital payment was a key focus of MACPAC’s January meeting with the Commission voting on Thursday to approve two sets of recommendations, the first addressing the structure of disproportionate share hospital (DSH) allotment reductions and the second directed to improving compliance with upper payment limit requirements. Both sets of recommendations are slated for inclusion in MACPAC’s March 2019 Report to Congress on Medicaid and CHIP.

Later that morning, the Commission discussed a study on performance and return on investment for state program integrity strategies. This session was originally scheduled for the December meeting. Following a break for lunch, the Commission was briefed on a new report by Mathematica Policy Research, under contract to MACPAC, regarding beneficiary enrollment in the Financial Alignment Initiative, which is testing new approaches to integrating care for people who are dually eligible for Medicaid and Medicare. Later, staff presented an analysis of the factors affecting physician decisions to accept new Medicaid patients.

Friday’s sessions opened with a panel of experts discussing how utilization management policies are applied to medication-assisted treatment (MAT). Under the SUPPORT for Patients and Communities Act (P.L. 115-271), MACPAC is required to study utilization management policies related to MAT and report on these by late October 2019. The meeting concluded with its third and final session on hospital payment: how to account for third-party payments in the DSH definition of Medicaid shortfall.

Supporting the commissioners’ deliberations were the following presentations prepared by MACPAC staff.

Because SNAP members serve so many Medicaid patients, MACPAC’s deliberations are especially relevant to them because its recommendations often find their way into future Medicaid and CHIP policies.

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 array of issues affecting Medicaid and the State Children’s Health Insurance Program.

PA Safety Net Admin2019-01-29T06:00:09+00:00January 29th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

MACPAC Meets

The non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP-related issues met recently in Washington, D.C.
The following is the Medicaid and CHIP Payment and Access Commission’s own summary of its meeting.

The December 2017 meeting of the Medicaid and CHIP Payment and Access Commission began with a brief update on the State Children’s Health Insurance Program (CHIP). Although federal funding for the CHIP expired at the end of September, legislation to renew funding was still pending in Congress. The Commission then heard from a panel discussing state tools to manage drug utilization and spending in Medicaid. Panelists included Renee Williams, director of clinical pharmacy services for TennCare; Doug Brown, Magellan Rx Management’s vice president for Medicaid drug rebate management; and John Coster, director of the Center for Medicaid and CHIP Services Division of Pharmacy at the Centers for Medicare & Medicaid Services. At the final morning session, Commissioners reviewed a draft March 2018 report chapter on streamlining Medicaid managed care authorities. The Commission voted to approve recommendations to Congress, but deferred action on a third recommendation for further discussion at its upcoming January 2018 meeting.

In the afternoon, MACPAC staff previewed highlights from the December 2017 MACStats: Medicaid and CHIP Data Book. MACStats pulls together Medicaid and CHIP data from multiple sources that often can be difficult to find. The collection is published annually and individual tables are updated throughout the year. The Commission then reviewed the draft March report chapter on telemedicine in Medicaid, and later in the day the Commission returned to the topic of prescription drugs, to explore potential recommendations on the Medicaid drug rebate program.

The final December sessions covered MACPAC’s annual analysis of disproportionate share hospital payments (a required element of its March reports), and findings from interviews with four states to better understand how they are implementing Section 1115 Medicaid-expansion waivers.

The following presentations, many with supporting documents, were offered during the MACPAC meeting:

PA Safety Net Admin2017-12-19T06:00:26+00:00December 19th, 2017|Federal Medicaid issues|Comments Off

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C.
Among the issues MACPAC commissioners discussed during their two-day meeting were:

delivery system reform incentive payment programs
Medicaid enrollment and renewal processes
managed care oversight
monitoring and evaluating section 11115 demonstration waivers
Medicaid coverage of telemedicine services

MACPAC advises the administration, Congress, and the states on Medicaid and CHIP issues. It is a non-partisan agency of the legislative branch of government.
Go here to find background information on these and other subjects as well as links to the presentations that MACPAC staff made to the commissioners during the meetings.

PA Safety Net Admin2017-09-21T06:00:10+00:00September 21st, 2017|Federal Medicaid issues|Comments Off

MACPAC Meets

Last week the Medicaid and CHIP Payment and Access Commission met in Washington, D.C. The agency performs policy and data analysis and offers recommendations to Congress, the Department of Health and Human Services, and the states.
During two days of meetings, MACPAC commissioners received the following presentations:

Federal CHIP Funding Update: When Will States Exhaust Their Allotments?
Review of June Report Chapter: Program Integrity in Medicaid Managed Care
Review of June Report Chapter: Medicaid and the Opioid Epidemic
Medicare Savings Program: Eligible But Not Enrolled
Medicaid Reform: Implications of Proposed Legislation
Preliminary Findings From Evaluations of Medicaid Expansions Under Section 1115 Waivers
Potential Effects of Medicaid Financing Reforms on Other Health and Social Programs
Review of June Report Chapter: Analysis of Mandatory and Optional Populations and Benefits
Managed Long-Term Services and Supports: Network Adequacy for Home and Community-Based Services
Update on MACPAC Work on Value-Based Payment and Delivery System Reform

For links to all of these publications and a transcript of the two-day meeting go here, to the MACPAC web site.

PA Safety Net Admin2017-05-05T06:00:59+00:00May 5th, 2017|Federal Medicaid issues|Comments Off

New MACPAC Reports

The Medicaid and CHIP Payment and Access Commission has released several new reports, including:

a look at how states exercise flexibility in their individual Medicaid programs;
methodologies for setting Medicaid per capita caps;
a review of how states are addressing high-cost hepatitis C drugs in their Medicaid programs;
an analysis of Medicaid disproportionate share hospital payment (Medicaid DSH) allotments and payments; and
an analysis of when states will exhaust their CHIP allotments.

MACPAC is a non-partisan legislative branch agency that advises Congress, the states, and the administration on Medicaid and CHIP payment and access issues.
Find links to these and other MACPAC reports here, on the MACPAC web site.

PA Safety Net Admin2017-04-18T06:00:00+00:00April 18th, 2017|Federal Medicaid issues|Comments Off

New MACPAC Study Evaluates Medicaid, Medicare Payments

Medicaid payments to hospitals are comparable to or even higher than Medicare payments.
Or at least they are once supplemental Medicaid payments are included.
So concludes a new study by the Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises the states, Congress, and the administration on Medicaid and CHIP payment and access issues.
In what MACPAC bills as the “first-ever study to construct a state-level payment index to compare fee-for-service inpatient hospital payments across states and to benchmark Medicaid payments to other payers such as Medicare,” the study found that

Across states, base Medicaid payment for inpatient services varies considerably, ranging from 49 percent to 169 percent of the national average. This variation is similar to the variation across states previously reported for physician fees.
States are not consistently high or low payers across all inpatient services due to differences in their payment policies.
Payment amounts for the same service can also vary within a state.

The MACPAC analysis also concluded that

Overall, Medicaid payment is comparable or higher than Medicare.
Specifically, the average Medicaid payment for 18 selected conditions was 6 percent higher than Medicare, and the average Medicaid payment for all but two of the conditions was higher than Medicare.
The average Medicaid payment for these 18 services was higher than Medicare in 25 states and lower than Medicare in 22 states.

Learn more about what MACPAC found – and how Pennsylvania Medicaid payments stack up – in the new MACPAC report “Medicaid Hospital Payment: A Comparison across States and to Medicare,” which can be found here, on MACPAC’s web site.

PA Safety Net Admin2017-04-14T06:00:19+00:00April 14th, 2017|Medicaid supplemental payments, Pennsylvania Medicaid policy, Uncategorized|Comments Off

MACPAC Looks at Medicaid DSH

Hospitals that serve especially large numbers of Medicaid and low-income patients still need Medicaid disproportionate share hospital payments (Medicaid DSH) to avoid red ink despite the expansion of Medicaid and the increase in the number of uninsured people fostered by the Affordable Care Act.
So concludes the Medicaid and CHIP Payment and Access Commission (MACPAC) the non-partisan legislative branch agency that advises Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on Medicaid and Children’s Health Insurance Program issues.
In its March 2017 report to Congress, MACPAC writes that

In both expansion and non-expansion states, deemed DSH hospitals, which are statutorily required to receive DSH payments because they serve a high share of Medicaid-enrolled and low-income patients, continue to report negative operating margins before DSH payments.

This finding reflects the experience of Pennsylvania safety-net hospitals, most of which consider Medicaid DSH to be absolutely critical to their financial health and continued ability to serve their communities.

Learn more about this evaluation, and other facets of the Medicaid DSH program, in this March 2017 report from MACPAC to Congress. Find a summary of the report here.

PA Safety Net Admin2017-03-24T06:00:43+00:00March 24th, 2017|Federal Medicaid issues, Medicaid supplemental payments|Comments Off

MACPAC Meets, Discusses Medicaid, CHIP Issues

The non-partisan legislative branch agency that advises Congress, the Secretary of Health and Human Services, and the states on a variety of Medicaid and State Children’s Health Insurance Program issues met last week in Washington, D.C.
Among the issues on the agenda of the Medicaid and CHIP Payment and Access Commission were:

the flexibility of states in structuring and administering their Medicaid and CHIP programs
state Medicaid responses to fiscal pressures
studies requested by Congress on mandatory/optional benefits and populations
current Medicaid parallels to per capita financing options
illustrations of state-level effects of per capita cap design elements
high-cost hepatitis C drugs in Medicaid
the role of section 1915(b) waivers in Medicaid managed care

Because Pennsylvania safety-net hospitals serve so many low-income Medicaid and CHIP beneficiaries, MACPAC’s deliberations are often very important to them.
Go here, to the MACPAC web site, for links to documents on all of these subjects.

PA Safety Net Admin2017-03-09T06:00:59+00:00March 9th, 2017|Federal Medicaid issues|Comments Off

MACPAC Looks at Medicaid DSH

With Medicaid disproportionate share payments (Medicaid DSH) facing future reductions, the agency charged with advising Congress on Medicaid and Children’s Health Insurance payment and access matters is considering what changes the federal supplemental Medicaid payment program might need.
At a recent meeting in Washington, D.C., the Medicaid and CHIP Payment and Access Commission discussed the changing role and purpose of Medicaid DSH as more Americans obtain health insurance through private or public sources. MACPAC commissioners noted that hospital uncompensated care is falling, especially in states that have taken advantage of the Affordable Care Act to expand their Medicaid programs.
A new Medicaid DSH formula set to be used for FY 2018, based more heavily than the current formula on the number of uninsured people in individual states, is expected to result in larger-than-average reductions for hospitals in Medicaid expansion states.
Among the steps commissioners discussed were examining how hospitals use their Medicaid DSH funds; considering how any changes in the distribution of Medicaid DSH funds might affect other parts of states’ health care systems; and the role states should play in determining the allocation of Medicaid DSH funds.
Medicaid DSH funds are a vital source of support to help Pennsylvania safety-net hospitals care for their many uninsured patients.
For a closer look at the issue and MACPAC’s deliberations, see this CQ Roll Call article presented by the Commonwealth Fund.

PA Safety Net Admin2016-09-26T06:00:26+00:00September 26th, 2016|Affordable Care Act, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

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