The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) Oct. 29 met to discuss draft chapters for its first disproportionate share hospital (DSH) report, policy levers that affect Medicaid spending, and trends in Medicaid spending for prescription drugs.
MACPAC’s first session focused on the upcoming Medicaid DSH report, which the commission is required to release annually beginning Feb. 2016. This first report will focus on the history of DSH payments, an analysis of current and future DSH allotments, and will make a recommendation focused on DSH-related data collection concerns. The recommendation is as follows:
- The Secretary of Health and Human Services should collect and report hospital-specific data on all types of Medicaid payments for all hospitals that receive them.
- In addition, the secretary should collect and report data on the sources of non-federal share necessary to determine net Medicaid payment at the provider level.
In the future, the commission plans to highlight policy proposals specifically focusing on DSH funding, including recommendations on rebasing state DSH allotments, modifying provider eligible criteria, and changing how eligible uncompensated care costs are defined.
MACPAC staff also reviewed policy levers that affect Medicaid spending and trends in spending for prescription drugs. In response to a letter from Congress, the commission examined several mechanisms to slow the rate of growth in Medicaid spending, including enrollment, prices, service volume and intensity, and value-based purchasing.
Commission staff reported that Medicaid spending for prescription drugs increased significantly in 2014 after years of low to moderate growth. Recent spending has been driven by enrollment growth due to Medicaid expansion and the increase of high-cost drugs. Staff noted that Medicaid has limited tools to manage drug utilization and spending, including prior authorization, statutory rebates, and cost sharing.