ADVI Analysis: MACPAC January 2024 Meeting

MACPAC held a meeting January 24-25 (link). The following relevant topics were discussed:

• Denials and Appeals in Medicaid Managed Care
• State Medicaid Agency Contracts (SMAC) Interviews with Key Stakeholders
• Findings from Expert Roundtable on Evaluating the Effects of Medicaid Payment Changes on Access to Physician Services
• Medicaid Coverage of Physician-Administered Drugs
• Vote on Recommendations for the March Report to Congress
• Medicare Savings Programs (MSPs): Enrollment Trends

ADVI Angle

Key takeaways from the January meeting include:

• Denials and Appeals in Medicaid Managed Care
  • Commissioners agreed with most of the recommendations, but much of their discussion focused on whether to recommend an external appeals review process for denied claims, with many commissioners split due to monetary and complexity concerns.
• SMAC Interviews with Key Stakeholders
  • Commissioners were concerned with limited state resources to utilize and enforce SMAC authorities and were interested in improving state capacity.
• Findings from Expert Roundtable on Evaluating the Effects of Medicaid Payment Changes on Access to Physician Services
  • Key findings from the roundtable: 1) Physicians are less likely to serve Medicaid patients 2) it’s unclear if payment increases could change that, and 3) provider consolidation may help Medicaid beneficiaries. Commissioners identified multiple areas for future study.
• Medicaid Coverage of Physician-Administered Drugs
  • Key findings from presentation: 1) There are several challenges in managing PAD use and spending, 2) MACPAC staff estimates are likely underestimates as drugs included in bundled payments were not included in total spend calculations.
• Vote on Recommendations for the March Report to Congress
  • Commissioners voted in favor of all recommendations, with some discussion around recommendations 2.1 and 2.6.
• Medicare Savings Programs (MSPs): Enrollment Trends
  • Key takeaway from presentation: MSP enrollment numbers have grown, indicating that efforts made by the federal and state governments to increase enrollment may have succeeded.

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