April 2022 Public Meeting

During the April 2022 Medicaid and CHIP Payment and Access Commission meeting, the Commission voted to approve a package of recommendations to:

create a new approach for monitoring access to care for Medicaid beneficiaries;
improve vaccine access for adult Medicaid beneficiaries;
improve the oversight and transparency of directed payments in Medicaid managed care; and
encourage the adoption of health information technology (IT) in behavioral health.

The recommendations will appear in MACPAC’s June report to Congress.

The meeting began with a review of recommendations and a draft chapter for the June report to Congress on a new approach for monitoring access to care for Medicaid beneficiaries. Staff presented a draft chapter with a package of five recommendations for a new access monitoring system. The chapter discusses the challenges and limitations of the current monitoring approach, the goals and key elements for a new system, and the rationale and implications for Commission recommendations that call on the Centers for Medicare & Medicaid Services (CMS) to develop a robust and ongoing access monitoring system.

Next, the Commission discussed a CMS request for information on access to care and coverage in Medicaid and CHIP that sought feedback on a wide range of access-related topics, including enrolling in and maintaining coverage, accessing services, and ensuring adequate payment rates.

MACPAC staff then presented a draft chapter on advancing health equity in Medicaid for the June report to Congress. The chapter highlights data showing the racial and ethnic composition of the Medicaid population, and the disparities affecting beneficiaries of color. In addition, the chapter discusses policy levers that states and the federal government can use to promote equity and lays the groundwork for future MACPAC work.

After this, staff presented a draft chapter for the June report to Congress with recommendations to improve vaccine access for adult Medicaid beneficiaries. Vaccines are important tools to promote public health, yet Medicaid-enrolled adults have lower vaccination rates than those covered by private insurance across nearly all vaccines. Since September 2020, the Commission has been exploring issues related to vaccine coverage and access for adults enrolled in Medicaid. The Commission included a chapter on vaccine access in its 2022 March report to Congress, which concluded with several policy considerations to improve vaccine access for Medicaid beneficiaries.

Staff then presented a draft chapter for the June report to Congress about the oversight of directed payments, a new option for states to require managed care plans to pay providers according to specified rates or methods. The Commission discussed recommendations to improve the oversight and transparency of directed payments in Medicaid managed care. The chapter includes a package of five recommendations related to improving the transparency of existing directed payment approval documents, rate certifications, and evaluations; collecting new, provider-level data on directed payment spending; clarifying directed payment goals and their relationship to network adequacy requirements; providing guidance for more meaningful, multi-year assessments of directed payments, and; improving the coordination of reviews of directed payments and managed care rate setting.

After a break, the Commission discussed recommendations designed to encourage health IT adoption among behavioral health providers. Over the course of the 2021–2022 meeting cycle, the Commission discussed the importance of behavioral health IT for care quality and patient safety. This presentation provided an overview of the draft chapter, which summarizes the barriers that behavioral health providers face in adopting electronic health records. The chapter then outlines where federal Medicaid guidance could explicitly encourage health IT adoption, and the role the federal government could play in improving the state of behavioral health IT.

To end the day, MACPAC staff presented an analysis of churn and coverage transitions for Medicaid beneficiaries. This presentation updated MACPAC’s previous analyses of enrollment data from the Transformed Medicaid Statistical Information System (T-MSIS) that was presented at MACPAC’s September 2021 public meeting. MACPAC found that gaps in Medicaid coverage are associated with increased rates of hospitalization for ambulatory care sensitive conditions. In addition, MACPAC found that few beneficiaries who disenroll from Medicaid subsequently enroll in exchange coverage, and when they do, they often experience a gap in coverage. The presentation concluded with a discussion of potential policy approaches to address these issues.

After the Commission voted on recommendations Friday, staff presented findings from a review of state practices for Medicaid managed care procurement. These procurements are among the largest state purchasing efforts, often exceeding billions of dollars. To understand how procurements may affect the delivery of services and achievement of policy goals, MACPAC conducted an extensive review of state practices for selecting managed care plans.

MACPAC found that states are using their purchasing power to encourage managed care plans to compete on their ability to support or advance program goals. However, managing a complex purchasing effort while simultaneously maintaining day-to-day program operations can be a significant challenge for state staff. Additional federal guidance and technical assistance could help improve Medicaid managed care procurement practices.

To end the meeting, MACPAC discussed potential comments on two reports. In January 2022, the Secretary of the U.S. Department of Health and Human Services (HHS) issued a report to Congress on Medicaid payment for services provided to beneficiaries in institutions for mental diseases under the in-lieu-of other services authority under managed care. HHS issued another report to Congress in February 2022 on best practices for prescription drug monitoring programs, including strategies for collaborating with Medicaid. This presentation summarized key findings from the two reports and identified potential areas for MACPAC comment.

Presentations