Medicaid managed care

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met publicly last week in Washington, D.C. The following is MACPAC’s own summary of its meeting. The MACPAC December 2024 meeting began with a discussion on accountability in Medicaid managed care, which is the predominant delivery system in Medicaid. MACPAC will examine the tools the Centers for Medicare & Medicaid Services (CMS) and state Medicaid agencies use to manage managed care organizations’ (MCOs) performance and hold plans accountable to contractual obligations. Staff presented findings from MACPAC’s review of federal policy and a 40-state review of accountability tools as described in [...]

joe2024-12-17T15:23:53-05:00December 18, 2024|Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations|

Federal Health Policy Update for June 13

The following is the latest health policy news from the federal government for June 7-13. Some of the language used below is taken directly from government document. Supreme Court The Supreme Court has agreed to hear a challenge to how the Department of Health and Human Services calculates hospitals’ Medicare disproportionate share (Medicare DSH) payments. The case was added to the court’s 2024-2025 schedule. Congress Individual members and key committees in Congress continue to introduce and mark up health care-related legislation with an eye toward including these initiatives in an end-of-year package. This work is expected to continue through the [...]

joe2024-06-13T20:15:06-04:00June 13, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for May 23

The following is the latest health policy news from the federal government for May 18-23. Some of the language used below is taken directly from government documents. Congress Leaders of the Senate Finance Committee have released a white paper outlining potential reforms of how Medicare pays physicians and how Medicare might better meet the needs of those with chronic illnesses. The white paper notes areas of interest the committee sees as opportunities for reform, including: Creating sustainable payment updates to ensure clinicians can own and operate their practices. Creating incentives for alternative payment models that reward providing better care at [...]

joe2024-05-23T18:28:33-04:00May 23, 2024|340b, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for March 21

The following is the latest health policy news from the federal government for March 15-21. Some of the language used below is taken directly from government documents. The White House The White House has announced new actions to advance women’s health research and innovation and issued an executive order in support of that objective. The order directs executive branch agencies to integrate women’s health across the federal research portfolio; prioritize investments in women’s health research; pursue new research on women’s midlife health; and assess unmet needs to support women’s health research. Learn more from this White House fact sheet, which [...]

MACPAC Issues Annual Report to Congress

The Medicaid and CHIP Payment and Access Commission has issued its annual report to Congress. This year’s MACPAC report primarily addresses three issues: How state Medicaid agencies can improve beneficiary engagement with state medical care advisory committees and what the federal government can do to facilitate that engagement. The current process for monitoring and overseeing denials of care and appeals of those denials by Medicaid managed care plans and how states and the federal government can improve those processes and make them more transparent. MACPAC’s annual review of Medicaid disproportionate share (Medicaid DSH) allotments to states. MACPAC is a non-partisan [...]

joe2024-03-20T14:28:46-04:00March 21, 2024|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days recently in Washington, D.C. The following is MACPAC’s own summary of the meeting. To kick off MACPAC’s November meeting, the Commission continued its work on denials and appeals in Medicaid managed care with a review of findings from beneficiary focus groups. Medicaid managed care organizations (MCOs) manage and provide care to beneficiaries enrolled in their plans. Beneficiaries have the right to appeal MCO coverage decisions. Federal rules require that states have monitoring systems in place to provide oversight of MCOs and their appeals systems. This session described key challenges [...]

iqtsupport2023-11-14T06:00:32-05:00November 14, 2023|Centers for Medicare & Medicaid Services, Congress, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations, Medicaid regulations for long-term care|

HHS Review Questions Medicaid Managed Care Plans

Medicaid managed care plans may be shortchanging their members on care – or so suggests a new review by the Department of Health and Human Services’ Office of the Inspector General. According to the OIG, the Medicaid managed care plans it audited in 37 states rejected one out of every eight requests for prior authorization, with more than ten percent of the audited plans denying prior authorization requests more than 25 percent of the time. Such findings, the OIG concluded, “…raise(s) concerns about health equity and access to care for Medicaid managed care enrollees.” To address this problem, the OIG [...]

iqtsupport2023-07-26T06:00:12-04:00July 26, 2023|Centers for Medicare & Medicaid Services, Medicaid, Medicaid managed care|

Federal Health Policy Update for July 20

The following is the latest health policy news from the federal government for March 13-16. Some of the language used below is taken directly from government documents. Congress Senator Bernie Sanders (I-VT), chair of the Senate Health, Education, Labor and Pensions (HELP) Committee, has introduced a bill, the “Primary Care and Health Workforce Expansion Act.” The bill would: Increase funding for community health centers by $65 billion over five years, fund the National Health Service Corps at $8.3 billion over five years, and provide $250 million for HRSA coordination for the Women, Infants, and Children (WIC) program. Add 10,000 graduate [...]

iqtsupport2023-07-20T16:54:58-04:00July 20, 2023|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Congress, COVID-19, health equity, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare regulations, Medicare reimbursement policy|

MACPAC Looks at Medicaid State Directed Payments

In 2016, the Centers for Medicare & Medicaid Services authorized states to direct Medicaid managed care organizations to pay providers according to specific rates or methods. Typically, states use these arrangements, often referred to as state directed payments, to establish minimum payments for certain types of providers or to require participation in value-based payment arrangements. A few states, though, use state directed payments to require Medicaid managed care organizations to make large, additional payments to providers similar to supplemental payments their Medicaid fee-for-service programs. In a new issue brief, the Medicaid and CHIP Payment and Access Commission describes the history [...]

iqtsupport2023-07-05T13:34:25-04:00July 5, 2023|Centers for Medicare & Medicaid Services, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the sessions. The March 2023 MACPAC meeting began with a staff presentation on potential recommendations for countercyclical disproportionate share hospital (DSH) allotments. Medicaid DSH payments offset hospital uncompensated care costs for Medicaid-enrolled and uninsured patients. During economic recessions, Medicaid enrollment and the number of people who are uninsured increases. During the October 2022 MACPAC meeting, Commissioners agreed that a countercyclical policy should be implemented during future economic recessions, and asked for additional analyses of the effects [...]

iqtsupport2023-03-10T06:00:08-05:00March 10, 2023|MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid managed care, Medicaid regulations for long-term care|