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  • Washington Highlights

    MACPAC Discusses Directed Payments in Managed Care and Confidentiality of Substance Use Disorder Patient Records

    Andrew Amari, Hospital Policy and Regulatory Specialist

    MACPAC Discusses Directed Payments in Managed Care and Confidentiality of Substance Use Disorder Patient Records

    The Medicaid and CHIP Payment and Access Commission (MACPAC) met Sept. 26-27 to discuss directed payments in Medicaid managed care and the Substance Abuse and Mental Health Services Administration (SAMHSA) proposed rule on 42 C.F.R. Part 2 (Part 2) confidentiality requirements for substance use disorder (SUD) patient records.

    MACPAC staff presented on directed payments in managed care and network adequacy standards. States may direct managed care payments to providers if they meet certain criteria, such the payment being tied to services provided under the managed care contract, advancing one of the goals of the state’s quality strategy, or not being contingent on agreements to provide intergovernmental transfer funding.

    In its analysis of these payments, MACPAC staff found that roughly 75% of directed payments are made through directed fee schedule arrangements, while the remaining quarter are value-based purchasing arrangements. MACPAC staff plan to monitor directed payment options for their 2019-2020 report cycle and are currently conducting interviews with states and managed care organizations on their approaches to promote the use of VBP arrangements in managed care, as well as oversight of directed payments.

    In their discussion, commissioners emphasized increased transparency of directed payments, requesting that staff attempt to identify the types and amounts of direct payments, and to which providers they are being made. Moreover, commissioners requested that staff determine how VBP arrangements drive utilization of services, as well as how states link network access measures to VBP arrangements. 

    MACPAC staff also presented on SAMHSA’s proposed changes to 42 C.F.R. Part 2, which governs disclosure of SUD treatment and prevention records. SAMHSA proposed to clarify situations when non-Part 2 providers are not subject to the Part 2 regulation, as well as allow patients to consent to disclosure of their SUD information to a broader range of entities without naming a specific person. Additionally, SAMHSA proposed to allow opioid treatment programs to disclose dispensing and prescribing data to Prescription Drug Monitoring Programs, subject to patient consent.

    MACPAC previously made recommendations on Part 2 in its June 2018 report to Congress [see Washington Highlights, June 22, 2018]. Commissioners noted that several of its 2018 recommendations were not addressed in the proposed rule and agreed that its comments on SAMHSA’s proposed rule should reinforce the commission’s past recommendations that were unaddressed. Specifically, the commissioners emphasized reinforcing past comments that the Part 2 regulations should clarify which providers are covered under Part 2, rather than which are not covered.

    Moreover, the commissioners voiced interest in reinforcing the commission’s past request for additional technical assistance and guidance on when information can be disclosed under Part 2. Finally, commissioners expressed support for the proposals that offer improved care coordination, noting past concerns that the current regulations may impede providers’ ability to integrate care.