Mid-December 2018, the Medicaid and CHIP Payment and Access Commission (MACPAC) held its monthly public meeting at the Ronald Reagan Building and International Trade Center in Washington, D.C.
The meeting covered a range of topics, including state innovations in drug pricing, network adequacy in managed care, disproportionate share hospital allotment reductions and proposed recommendations, upper payment limits for hospitals, a review of the proposed rule affecting integrated care for dually eligible beneficiaries, and a panel discussion on Medicaid in Puerto Rico.
Rebekah Gee, secretary of the Louisiana Department of Health, and Paul Jeffrey, director of pharmacy at MassHealth, began the meeting on Thursday, December 13th, with a panel discussion of their states’ innovative strategies and novel drug pricing schemes to counter the rising cost of prescription drugs. The possibility of establishing safe harbors to the Medicaid Best Price rules to facilitate alternative drug payment programs was also discussed. Later that morning, the Commission looked at how states with Medicaid managed care programs oversee network adequacy and access to care. There, Commissioners expressed interest in staff conducting more research into the effectiveness of metrics other than time and distance, how states react to network adequacy gaps, and how different modalities of care are treated.
That afternoon, the meeting continued as the Commission discussed options for recommendations on how to structure DSH allotment reductions and proposed recommendations to improve compliance with upper payment limits for hospitals, which are expected to be part of the March 2019 report to Congress. The Commission is expected to vote on these recommendations at its January 2019 meeting. The Commission also looked at a proposed rule to revise managed care regulations. At the final session of the day, the Commission reviewed another proposed rule to improve the integration of Medicare and Medicaid benefits and unify the grievance and appeals processes for dually eligible beneficiaries enrolled in dual eligible special needs plans. While Commissioners were generally supportive of the proposed rule, they also emphasized the point that CMS should continue to strive toward building a fully integrated system.
Friday morning started with a panel to advise the Commission’s consideration of Medicaid in Puerto Rico. Angela Avila, executive director of Puerto Rico’s Administración de Seguros de Salud, Orlando Gonzalez, president of the managed care organization MMM Healthcare, and Gloria Amador, chief executive officer of the federally qualified health center Salud Integral en la Montaña, Inc., discussed challenges and opportunities for Medicaid in the commonwealth. The panel was followed by a presentation highlighting key facts and trends from the just-released December 2018 edition of the MACStats data book. The Commission deferred review of the results of a study assessing return on investment in 10 different Medicaid program integrity approaches until its January meeting.
The next MACPAC meeting is scheduled for January 24-25, 2019 in Washington, D.C.