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  • Washington Highlights

    MACPAC Discusses Exemptions to Monitoring Access in FFS, UPL Supplemental Payments to Hospitals

    Andrew Amari, Hospital Policy and Regulatory Specialist

    The Medicaid and CHIP Payment and Access Commission (MACPAC) met April 19-20 to discuss several issues, including the Centers for Medicare and Medicaid Services (CMS) proposed rule on exemptions to monitoring access in Medicaid fee-for-service, as well as uses and oversight of upper payment limit (UPL) supplemental payments to hospitals.

    MACPAC staff offered a brief review of the role of monitoring access and the current state reporting requirements. The proposed rule exempts states from their access monitoring review plan (AMRP) requirements in two situations: when the state has high Medicaid managed care enrollment (above 85 percent), and when payment rate changes are considered nominal (four to six percent depending on the term of the plan).

    Commissioners agreed that both thresholds were too arbitrary. The first would leave significant portions of vulnerable populations open to inequitable access to care and the second would have varied effects based on the state’s current payment levels. In addition, the commission agreed that due to judgments denying individuals and providers a private right of action, CMS alone bears the burden of protecting its Medicaid population and must do so through the rule. The AAMC plans to submit comments on these issues by the May 22 comment deadline.

    MACPAC staff also presented on the uses and oversight of UPL supplemental payments to hospitals, including MACPAC’s own findings related to these payments. The commission found that although states reported they could make $12.4 billion more in UPL supplemental payments, their actual UPL spending was underreported by roughly $11 billion. The commission expressed concern over the large discrepancy in actual and reported UPL payments. Specifically, the commissioners suggested that there is no process to account for the discrepancy and that data are not being used to account for the discrepancy’s causes. The commission plans to seek additional information from CMS about the discrepancy and use of data, and plans to highlight the issue to Congress.