The Medicaid and CHIP Payment and Access Commission (MACPAC) met on Feb. 27 and 28 to discuss a variety of topics including an analysis of targeting of non-disproportionate share hospital (DSH) supplemental and managed care directed payments, access to treatment and medications for opioid use disorder (OUD), and the automation of prior authorization.
In the supplemental payment session, commissioners reviewed an analysis of non-DSH supplemental payments focused on upper payment limit (UPL) and graduate medical education (GME) payments. The analysis showed that UPL payments varied based on several factors and often resulted in targeted payments going to government-owned, rural, or teaching hospitals. GME payments targeted teaching hospitals with some states prioritizing targeting primary care and high-need specialties. The commission plans to continue their analysis and construct an updated hospital payment index to assess and compare fee-for-service and managed care payments.
The commission built on its analytical work related to access to medications for OUD by discussing stakeholder interviews conducted around federal policies and funding, stigma and misinformation, provider availability, and utilization. The commission plans to include these interviews in a chapter in their June report to Congress. MACPAC also held a panel discussion with state Medicaid officials and an expert on substance use disorders (SUDs) on states’ use of Section 1115 waivers to receive federal matching funds for SUD services provided in institutions for mental diseases (IMDs). The panel explored state success and challenges in leveraging 1115 waivers to expand treatment for SUDs in IMDs, which typically are subject to the IMD exclusion prohibiting them from receiving federal matching funds for treating Medicaid beneficiaries. Lastly, commissioners reviewed MACPAC’s project on how automation is being used in the Medicaid prior authorization process and the available federal and state levers to regulate the use of automation. The commission plans to conduct a literature review, federal policy review, and stakeholder interviews of seven states as well as develop state profiles. As a next step, MACPAC plans to include a panel discussion on automation in its April meeting.