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MACPAC Talks Medicaid Rules, Hospital Payment Index at September Meeting

September 26, 2024
Julie Kozminski

At a September meeting, the Medicaid and CHIP Payment and Access Commission (MACPAC) discussed recent Centers for Medicare & Medicaid Services (CMS) final rules, the hospital payment index, home- and community-based services (HCBS), and youth services.

CMS Final Rules

MACPAC summarized provisions in four recently issued final rules on eligibility and enrollment, access to care, managed care, and nursing facility staffing and payment transparency. For each rule, staff outlined key requirements, highlighted how CMS responded to MACPAC comments on the rules, and discussed how the new rules relate to ongoing and future work during this analytic cycle.

For the managed care access, finance, and quality rule, commissioners discussed:

  • Disappointment with nonstandardized data in the managed care space and lack of patient experience data
  • How the rule considers CMS approves for state directed payments to managed care plans
  • Whether the rule considered value-based payment models as part of its annual provider payment analysis

The discussion on the access rule focused on HCBS requirements.

Hospital Payment Index

Staff presented recommendations from a technical expert panel (TEP) to update an earlier MACPAC state-level hospital payment index to compare fee-for-service inpatient hospital payments across states and with Medicare payment rates.

The TEP comprised federal and state government representatives, hospital leaders, consultants, and researchers. Key themes from the TEP included methods to calculate Medicaid payments using available data sources, meaningful benchmarks for Medicaid payment comparison, methods to account for supplemental payments and provider financing, and uses for the payment index.

Commissioners took interest in the role of small rural hospitals, safety-net hospitals and academic medical centers, and differences in for-profit and nonprofit hospitals.

MACPAC meets six times a year and submits reports to Congress in March and June. MACPAC’s next public meeting is Oct. 31.

Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.

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