June 23, 2022

MACPAC Report to Congress Focuses on Transparency for Provider-Level Data

The Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) released its June Report to Congress, June 15. The report includes several recommendations to the secretary of the U.S. Department of Health and Human Services. MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress.

The American College of Radiology® (ACR®) developed a summary of the radiology-relevant topics included in the report.

To increase the transparency and provide additional clarity on direct payments made to Medicaid managed care organizations (MCOs), MACPAC suggested measures that include making provider-level data and directed payment approval documents publicly available on the Medicaid.gov website and requiring states to develop rigorous multi-year evaluation plans to quantify how directed payment amounts compare to prior supplemental payments. MACPAC aims to understand how much is being spent and the extent to which these payments are advancing quality and access goals for Medicaid managed care patients.

Out of the 12.2 million people who are dually eligible for Medicaid and Medicare, only about one million full-benefit dually eligible beneficiaries were enrolled in integrated care models in 2020. MACPAC urges Congress to make integrated care the standard for these dually eligible beneficiaries and recommends requiring all states develop an integration strategy within two years with specific components. Integrating care for these beneficiaries has the potential to improve care and reduce federal and state spending.

To improve Medicaid’s role in advancing health equity, the report highlighted key areas for policy development. These include collection and reporting of race and ethnicity data, beneficiary engagement in the policymaking process, the role of state leadership in prioritizing a health equity agenda, and development of a diverse and culturally competent workforce. Over the next year, MACPAC will continue using a health equity lens throughout its work.

For questions, please contact Kimberly Greck, ACR Economic Policy Analyst, or Christina Berry, ACR Team Lead, Economic Policy.