The Medicaid and CHIP Payment and Access Commission (MACPAC) met March 5-6 to discuss topics including automation in prior authorization, recommendations for accountability of Medicaid managed care plans, mandatory and optional spending in Medicaid, and the latest MACStats publication. Commissioners first reviewed the use of automation in prior authorization in Medicaid, including three guiding policy principles and four potential policy options. The policy options reviewed by the commission call for clarification regarding the need for clinical expertise in the review and approval of denials; guidance for state oversight of Medicaid managed care plans’ use of automation tools; requirements for denial reviews to be assessed by humans with appropriate clinical experience in Medicaid fee-for-service plans; and requirements to disclose the use of automation in prior authorization in state managed care contracts.
Commissioners then reviewed two draft recommendations to ensure accountability of Medicaid managed care plans. The first draft recommendation directs the Centers for Medicare & Medicaid Services (CMS) to provide guidance on the types of accountability actions that should be reported on Managed Care Program Annual Reports and how states should consistently report these. The second draft recommendation directs the CMS to develop a publicly available database on managed care plan performance that links federally mandated reported data together and to issue guidance to states on how to effectively use these data. Commissioners will vote on these recommendations in the April meeting, to be included in the June report to Congress. Commissioners reviewed findings on Medicaid enrollment and spending on mandatory and optional services, finding that most Medicaid spending and enrollment was for mandatory populations and services, driven by acute hospital services and other acute services. Lastly, commissioners reviewed MACPACs latest MACStats publication, which was released in February and includes trends and key statistics related to program enrollment, spending, eligibility, and beneficiary utilization and access to care.