ADVI Analysis: MACPAC Meeting January 2023

Medicaid and CHIP Payment and Access Commission (MACPAC) Meeting: January 2023 Executive Summary

The MACPAC held a meeting on January 26-27, 2023 (link). The following relevant topics were discussed.

• Medicaid coverage based on Medicare National Coverage Determination (NCD): Review of recommendations and draft chapter for March report
• Discussion of Potential Responses to HHS Rulemaking
• State update on unwinding the Public Health Emergency (PHE)

ADVI Angle

The following are key takeaways from the January meeting.

• Medicaid coverage based on Medicare National Coverage Determination (NCD): Review of recommendations and draft chapter for March report
  • MACPAC Staff presented a draft chapter and recommendation to allow states to follow a Medicare NCD or CED requirements.
  • Commissioners voted to advance the following recommendations to be included in the March 2023 Report to Congress:
    • Congress should amend § 1927(d)(1)(B) of the Social Security Act to allow states to exclude or otherwise restrict coverage of a covered outpatient drug based on coverage with evidence development requirements implemented under a Medicare national coverage determination.
    • Congress should amend Section 1903(m)(2)(A)(xiii) to require the managed care contract conform to the state’s policy with respect to any exclusion or restriction of coverage of a covered outpatient drug based on coverage with evidence development requirements implemented under a Medicare national coverage determination.
  • Discussion of Potential Responses to HHS Rulemaking
    • MACPAC Staff presented on comment opportunities for the Commission in the following proposed rules: Notice of Benefit and Payment Parameters for 2024, Contract Year 2024 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs, and the Confidentiality of Substance Use Disorder (SUD) Patient Records.
  • State update on unwinding the Public Health Emergency (PHE)
    • MACPAC Staff along with state panelists from CO, OK, and NV, provided an update on how states are planning for the unwinding of the continuous coverage requirement considering the passage of the 2023 Consolidated Appropriations Act (CAA, P.L. 117-328).

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