November 05, 2019

October MACPAC Meeting Shifts Focus to Integrated Care for Dually Eligible Beneficiaries

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened its Commissioners October 31 and November 1 in Washington, DC to discuss action items and potential recommendations ahead of its March 2020 report to Congress. The MACPAC releases its reports to Congress twice annually, by March 15 and June 15, respectively. The ACR Medicaid Network representatives and economics and health policy staff monitor local Medicaid programs, review local coverage policies and track MACPAC activities.

During the meeting a few topics were discussed:

  • Panel on Integrating Care for Dually Eligible Beneficiaries: Perspectives from Beneficiaries, Providers and Plans
  • State Readiness to Report Mandatory Core Set Measures
  • Findings on Effects of New Buprenorphine Prescribing Authority for Nurse Practitioners and Physician Assistants
  • Update on Transformed Medicaid Statistical Information System (T-MSIS)
  • Required Analyses of Disproportionate Share Hospital Allotments

Meeting Highlights

Integrated care models are designed to align the delivery, payment and administration of Medicare and Medicaid services to improve care for dually eligible beneficiaries and reduce spending. The federal government and states are testing a variety of models to integrate care for beneficiaries enrolled in both Medicare and Medicaid. ACR members interested in Medicaid can expect the MACPAC Commission recommendations to Congress will focus on improving the Medicaid enrollment process and choice for dually eligible beneficiaries. Amber Crist, Directing of Attorney for Justice in Aging, reported 41% of enrollees in Medicaid opted out of the dual demonstration after being passively enrolled in the program. Perspectives from providers and the payer community included practical examples and stats on the importance of integrated care to foster collaboration across the health care system, such as reductions in hospital visits and incentives to foster innovation at the community level. Key barriers around network adequacy, information sharing between systems, attribution and the need for providers — both primary care and specialists — to better manage and understand the dually eligible population. The Commissioners noted more attention to this topic is necessary, as only 23 states have adopted an integrated care model in Medicaid vs. traditional fee for service. More evidence is needed to study the effects of integrated care on Medicare and Medicaid spending and outcomes for dually eligible beneficiaries.

MACPAC discussed State readiness to report on mandatory core set measures set to take effect in 2024. In FY 2019, there are 26 measures in the child core set and 12 behavioral health measures in the adult core set. State reporting of the core measures has increased over the last seven years, but varies by state. MACPAC contracted with Mathematica to examine state planning efforts and perceived challenges for mandatory reporting; interviews were held with 7 state Medicaid plans. The analysis found that states and plans cannot fully prepare for mandatory reporting without additional guidance and technical specifications from the Centers for Medicare and Medicaid Services (CMS). They will also need additional staff to handle the administrative takes of core set reporting, as this will compete with other state quality initiatives and resources. CMS is considering ways to reduce state burden before reporting is mandated in 2024.

The Commissioners also examined prescribing patterns among advanced practitioners, such as NPs and PAs. MACPAC contracted with IMPAQ International to examine the effect of the Comprehensive Addiction and Recovery Act of 2016 (CARA) on access to Opioid Use Disorder (OUD) treatment for Medicaid beneficiaries analyzing claims from July 2017 to June 2018. Overall, trends show an increase in total number of buprenorphine prescribers by 12 % (79% increase for NPs and 49% increase by PAs). The number of patients treated by advanced practitioners increased substantially; most patients still receive prescriptions by physicians. Learn more about the topic in the Health Affairs blog.

Chris Park, Principal Analyst, provided an update on the Transformed Medicaid Statistical Information System (T-MSIS). T-MSIS is a critical data and systems component of the CMS information technology (IT) infrastructure. It includes data on enhanced information about beneficiary eligibility, beneficiary and provider enrollment, service utilization, claims and managed care data and expenditure data for Medicaid and CHIP. An analysis was conducted May of 2019 on the use of this system and validating data quality. Most states and some territories are submitting data on a monthly. However, data quality can be improved as several operational and technological challenges have occurred since its implementation in 2013, due to transitions from the previous data system. After the data quality check, only 39 states have complete data sets, but 14 of these have questionable or poor data; this will affect information in the December 2019 MACPAC data book. CMS is planning to release updated Medicaid enrollment numbers November 2019, based on 2014–2016 data elements submitted. CMS and its contractor will continue to map T-MSIS and MSIS data elements and identify payment, program type, and type of service.

Commissioners wrapped up the first day of the meeting discussing a recent analysis of Disproportionate Share Hospital (DSH) allotments and evaluation of California’s global payment program. As of 2018, there are 27.5 million individuals uninsured, and 2.0 million fewer individuals are enrolled in Medicaid and CHIP. In 2017, hospitals reported a total of $39.9 billion in uncompensated care costs on its Medicare cost reports. MACPAC in its June 2019 report recommended a statutory change to combat this issue.

Many of the topics and concepts outlined will be further discussed at the next MACPAC meeting in December 2019, where its draft recommendations and report content will be formulated.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). A full list of MACPAC Commission Members is available here.

For questions regarding the Medicaid Network at the ACR, please contact Alicia Blakey or Christina Berry.