The Medicaid and CHIP Payment and Access Commission (MACPAC) met on Sept. 19 and 20. The commissioners discussed a variety of topics including recently finalized rules and themes from the Hospital Payment Index Technical Expert Panel (TEP).
In the first session, commissioners reviewed three recent Medicaid final rules from the Centers for Medicare & Medicaid Services (CMS) including the Eligibility and Enrollment Final Rule [refer to Washington Highlights, March 29], the Access to Services Final Rule [refer to Washington Highlights, April 26], and the Managed Care Access, Finance, and Quality Final Rule [refer to Washington Highlights, April 26]. Commissioners highlighted concerns around continuous coverage for pregnant and post-partum beneficiaries, loss of flexibility especially in Medicaid managed care plans, and lack of understanding related to the Medicaid beneficiary experience. The commission also reviewed the Nursing Facility Staffing and Payment Final Rule [refer to Washington Highlights, April 26] and the current legal challenges facing this final rule.
Additionally, MACPAC utilizes a TEP comprised of a range of industry stakeholders to update a state-level hospital payment index used to compare Medicaid inpatient hospital payments across states and to Medicare rates. As part of the commissioners’ work, they reviewed and discussed key themes from the TEP including methods to calculate Medicaid payments using available data sources, benchmarks for Medicaid payment comparison, methods to account for supplemental payments and provider financing, and uses for the payment index. MACPAC plans to build on this work by updating the payment index to incorporate fee-for-service and managed care payments as well as reviewing upper payment limit narratives and state directed payment (SDP) preprints to understand how states are using SDPs to target certain classes of providers. Commissioners discussed highlighting certain categories of hospitals in their payment analysis, including safety-net hospitals, academic medical centers, and rural hospitals.