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Tag Archive | "MACPAC"

MACPAC Releases Report on Medicaid Managed Care

The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2011 Report to the Congress: The Evolution of Managed Care in Medicaid. The Commission’s report provides an overview of Medicaid managed care, including information on populations enrolled, plan arrangements, payment policy, access and quality, as well as program accountability, integrity, and data.

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MACPAC Convenes Meeting Focused on Managed Care

In considering the Medicaid expansion beginning in 2014, states may seek to encourage Medicaid managed care plans to offer both Medicaid and health insurance exchange coverage, in order to prevent disruptions in coverage as individuals shift in and out of Medicaid eligibility based on changes in their income level.  On May 19, the Medicaid and CHIP Payment and Access Commission (MACPAC) convened to discuss managed care, which is among its highest priorities and will be the focus of the Commission’s June 2011 Report to Congress.  State Medicaid Directors in New York and Oklahoma discussed current managed care initiatives as well as identify challenges and opportunities for the future.  Both states have a long history of managed care and note that it will have a significant role in the future to ensure coverage while establishing the correct incentives for appropriate utilization of care.  The New York State Medicaid Director noted that the underlying question that remains to be answered is whether managed care controls costs over time.

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MACPAC Releases 2011 Report to Congress

In its first report, MACPAC does not make recommendations to Congress. The report (1) provides an overview of Medicare and Medicaid; (2) sets forth the analytical framework that MACPAC will use to consider policy issues; (3) outlines factors for accessing access, evaluating payment policies, and identifying key data sources; and (4) includes a compilation of key data on Medicaid and CHIP enrollment, program characteristics, and expenditures.

MACPAC reviews the history of Medicaid and the State Children’s Health Insurance Program (CHIP) and the importance of their roles at the local, state, and Federal levels.  The report explains Medicaid and CHIP’s impact on state and federal budgets, and emphasizes the fiscal difficulties states face in the midst of an economic recession.  The report emphasizes Medicaid’s unique role of covering services often not covered by under traditional health insurance, while being subject to and struggling to adhere to medical cost drivers, such as medical malpractice patterns and new, high-cost technologies.  MACPAC highlights two major upcoming policy changes – CHIP’s interaction with exchange coverage and when new federal CHIP funding will not be available under current law, as authorized by the Affordable Care Act.  It notes that there is a potential for cases where children who are eligible for CHIP (or Medicaid) will be prohibited from enrolling in their parents’ federally subsidized family coverage through an exchange due to new eligibility requirements.

The Commission’s evaluation of access to primary and specialty care will focus on study of enrollees and their characteristics, availability of providers, and utilization.  MACPAC intends to identify a set of measures by which to monitor access and to identify opportunities that would appropriately enhance access to Medicaid and CHIP.  The report outlines potential measures that could be used for this purpose.

MACPAC also outlines potential areas for the Commission’s work in evaluating Medicaid payment policies, including: (1) evaluate the impact of the required increase in primary care fees; (2) evaluate specific payment policies for improving efficiency, economy, and quality and increasing availability of providers; and (3) examine the impact of state financing approaches and supplemental payments on providers, payment policy, and states’ ability to adopt payment innovations.

Consistent with Commission meetings, the report includes a chapter focused on improving Medicaid and CHIP data. The chapter outlines the current data sources used to collect Medicaid and CHIP data. The report acknowledges that the Centers for Medicare and Medicaid Services (CMS) is working to resolve data issues and update its computer and data systems. MACPAC, in its report, urges CMS to move forward with these efforts and also to develop a strategic plan to gather feedback from stakeholders. The Commission outlines the specific data areas for improvement: (1) encounter data by managed care plans; (2) timeliness of enrollment; (3) consistency of data across sources; and (4) information about state program policies.

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Capital Thinking Update

Diane Rowland, Chair of the Medicaid and CHIP Payment and Access Commission (MACPAC), announced that Lu Zawistowich was named the Commission’s Executive Director and that the first public MACPAC meeting will be convened in September. The Commission was authorized in the Children’s Health Insurance Program Reauthorization of 2009 (P.L. 111-3). Congress appropriated funding for MACPAC in the Affordable Care Act.  MACPAC will advise Congress on Medicaid, CHIP, and health insurance exchange policies.

Dr. Zawistowich most recently served as the Acting Deputy Director of the Office of Consumer Information and Insurance Oversight at the Department of Health and Human Services. She previously worked at the Centers for Medicare and Medicaid Services as well as at the Maryland State Department of Health and Mental Hygiene.

On July 21, Democratic Rep. Lynn Woolsey introduced H.R. 5808 to amend the Affordable Care Act (ACA) to include a public plan option. The Congressional Budget Office CBO issued a letter to House Ways and Means Health Subcommittee Chairman Pete Stark noting that the bill would reduce the budget deficit by $53 billion over 10 years. The letter also states that the cost of insurance under a public plan option would be 5-7 percent lower on average.

Including a public plan option in health care reform legislation was a controversial issue that did not ultimately have traction in the Senate’s Patient Protection and Affordable Care Act. The House-passed health care reform bill included a public plan option.  The rates under the Affordable Health Care for America Act would be negotiated and could not be less than Medicare rates, but not higher than the average rates of other health benefit plans. Rep. Woolsey’s legislation would set reimbursement rates under the public plan option as equal to Medicare plus 5 percent. Although the legislation has 128 co-sponsors, the House is unlikely to move the bill during this session of Congress.

The National Association of Insurance Commissioners convened last week to develop a recommendation to HHS regarding the definition of medical loss ratio, which would serve determine the types of insurance spending that should count as medical spending. NAIC was charged with this role in the Affordable Care Act, which requires large group health insurance plans to spend 85 percent of premium dollars on clinical services and activities related to quality of care. The NAIC hopes to present a recommendation to HHS by mid to late August; although, its work could continue into September. Secretary Kathleen Sebelius must certify the Commissioners work. NAIC has also been tasked with developing standard insurance benefits and enrollment forms and regulations for the state-based exchanges.

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