News

MACPAC Holds March 2024 Meeting

• The Medicaid and CHIP Payment and Access Commission (MACPAC) met on March 7 and 8 to discuss the following topics (MACPAC, March 7):
  • Proposed Recommendations for Improving the Transparency of Medicaid Financing: MACPAC staff introduced draft text of the proposed recommendations for MACPAC’s June 2024 report to Congress. The proposal included the following recommendations: “Congress should amend Section 1903(d)(6) of the Social Security Act to require states to submit an annual, comprehensive report on their Medicaid financing methods and the amounts of the non-federal share of Medicaid spending derived from specific providers and Congress should amend Section 2107(e) of the Social Security Act to apply the Medicaid financing transparency requirements of Section 1903(d)(6) of the Social Security Act to CHIP.” These recommendations are projected to enhance the transparency of Medicaid financing methods, and state and provider financing amounts.
  • Medicaid Home- and Community-Based Services: Addressing Administrative Requirements: MACPAC staff presented follow-up information from their November 2023 meeting. MACPAC analysts presented results from supplementary interviews with federal officials and policy experts that examined three specific areas: lack of technical guidance, the resource intensive renewal process, and the cost neutrality requirement. Staff also presented the following three policy options for commissioner consideration: “The Secretary of the U.S. Department of Health and Human Services should direct the Centers for Medicare & Medicaid Services to develop an authority-specific technical guide for Section 1915(i), Congress should amend Section 1915(c)(3) and Section 1915(i)(7)(C) of Title XIX of the Social Security Act to increase the renewal period beyond five years, and Congress should amend Section 1915(c)(2)(D) of Title XIX of the Social Security Act to remove the cost neutrality requirement.”
  • Optimizing State Medicaid Agency Contracts: Policy Options: MACPAC staff presented policy options on how states use their state Medicaid agency contracts with Medicare Advantage (MA) dual eligible special needs plans to integrate care for dually eligible beneficiaries, how these contracts are overseen, and the barriers that states face to leveraging these contracts. These options are based on findings initially presented in the January 2024 meeting. Staff described two policy options for consideration: states collect data on care coordination and MA encounters; and, CMS issue guidance supporting states in developing an integration strategy.
  • Findings from Interviews about Medicaid Payment Policies to Support the Home- and Community-Based Services Workforce: The MACPAC session reviewed findings from interviews focused on Medicaid payment policies for home- and community-based services (HCBS) that are used to support HCBS workers, including direct care workers, direct support professionals, and independent providers. Potential practices addressed include: conducting data-driven rate studies that account for current needs in place of budget-based rate studies; aligning payment rate assumptions across populations, services, and delivery systems; and routinely updating rates to account for a changing HCBS policy environment. The presentation also focused on challenges states face in funding HCBS rates at recommended levels and ensuring rate increases result in increased HCBS worker wages.
  • Themes from Expert Roundtable on Physician-Administered Drugs: MACPAC staff discussed background information regarding the Medicaid Drug Rebate Program (MDRP) and policy differences between pharmacy and Physician-Administered Drugs (PADs). Additionally, the staff hosted a roundtable discussion on possible strategies states can use to better manage spending for related treatments and how to help states address the existing challenges related to PADs.
  • Transitions of Coverage and Care for Children and Youth with Special Healthcare Needs (CYSHCN): MACPAC staff discussed the vital role that Medicaid plays for the coverage of CYSHCN services and the need for a smooth transition to adult coverage when they come of age. Additionally, staff spoke about the barriers that beneficiaries and their families face during the transition, such as lack of care coordination, provider availability, few CPT transition codes, and limited coordination between pediatric and adult providers. MACPAC staff also noted there is significant variability in terms of population definition, plan options and eligibility for the CYSHCN population.
  • Medicare Savings Program: Enrollment Trends: The Commission previewed a draft of the Medicare Savings Programs (MSPs) chapter for the June 2024 report to Congress. This chapter describes MSPs and their role in providing Medicaid assistance with Medicare premiums and cost sharing to individuals who are dual eligibles. The chapter provides an overview of MSPs, discusses prior work in analyzing participation rates, and discusses research into participation in each of the MSPs for calendar years 2010 through 2021, including enrollment trends by demographic characteristics.
  • Panel Discussion on Authorities and State Medicaid Approached for Covering Health-Related Social Needs: Panelists Dave Baden, Deputy Director for Programs and Policy at the Oregon Health Authority; Amir Bassiri, Medicaid Director at the New York State Department of Health; Elizabeth Hinton, Associate Director at KFF; and Hemi Tewarson, Executive Director at the National Association of Health Policy discussed a variety of authorities and state Medicaid approaches for covering health-related social needs (HRSN). Panelists illustrated how they are providing services, such as housing and nutritional supports, through Medicaid authorities with a focus on design considerations, implementation, and future trends.

Biden Releases $7.3 Trillion Budget Proposal for FY2025

• On Monday, President Biden released his proposed budget for FY2025. The $7.3 trillion dollar budget aims to build on the administration’s progress to lower costs for working families, protecting and strengthening Social Security and Medicare, investing in America and the American people, and reducing the deficit by cracking down on fraud, cutting wasteful spending, and making wealthy populations and corporations pay higher taxes. The proposed FY2025 budget also reduces the deficit by $3 trillion over the next 10 years. Additionally, the budget proposal aims to protect and increase access to quality, affordable healthcare, increase access to affordable housing, and advance equity. Fact sheets for each piece of President Biden’s budget are located here (The White House, March 11; Inside Health Policy, March 11).

CMS Releases an Informational Bulletin on Strategies to Improve Delivery of Tobacco Cessation Services

• Smoking is the cause of approximately 480 thousand deaths in the U.S. every year, leading to over $600 billion a year in medical costs and productivity loss. Research shows that in 2021, one in five adult Medicaid enrollees smoke cigarettes. On March 7, CMS released a Center for Medicaid and CHIP Services informational bulletin to delve into possible strategies to improve the delivery and impact of tobacco cessation services. It includes information regarding the burden of smoking and related diseases prevalent in Medicaid and CHIP enrollees; benefits of cessation, evidence-based treatment, and how to create opportunities for enrollees to quit smoking; tobacco cessation coverage requirements for states; strategies for states to improve delivery of services; quality measures to track improvement, and additional resources (CMS, March 7).

CMS Releases Website Focused on Sickle Cell Disease Treatment Access and Quality

• CMS has released information on Medicaid and CHIP coverage of new treatments for sickle cell disease (SCD) through a new webpage. The webpage includes information presented to state Medicaid and CHIP officials in February 2024, reports on demographics, health, and healthcare of individuals with SCD, and quality improvement tools that states can use to improve SCD care (CMS, March 11).

Fertility Coverage Mandated in CMS’ Cell and Gene Therapy (CGT) Model

• According to a Request for Application (RFA) released by CMS, cell and gene therapy (CGT) manufacturers who voluntarily participate in the CMS innovation center’s new CGT model will be required to pay for fertility preservation services at no cost to patients. CMS previously announced that it will focus on sickle cell treatment for the initial CGT model. Responses to the RFA are due on May 1 for sickle cell treatment providers and negotiations are expected to occur between May 2 and November 29. Additionally, CMS also intends to release an RFA and notice of funding opportunity to states interested in participating in the CGT model sometime this summer. States will be able to opt into the program on a rolling basis, but CMS is asking for interested states to submit nonbinding letters of intent by April 1 (Inside Health Policy, March 7).

HHS Issues Letter Urging Providers to Remain Strong Despite Change Healthcare Cyberattack

• On March 10, HHS issued a letter to healthcare leaders asking them to ensure that providers stay afloat after the cyberattack on Change Healthcare, a subsidiary of UnitedHealth Group. Change Healthcare suffered a ransomware cyberattack late in February, which put payments for hundreds of millions of insurance claims in abeyance. The hacking group was purportedly paid $22 million in bitcoin to release the information, but Change Healthcare’s systems remain in disarray and claims are still not being paid. The company processes approximately 15 billion claims per year, about half of the U.S. market. In their letter, HHS urges other payers to make interim payments to providers, particularly those participating in the Medicaid program (Health Payer Specialist, March 11).

Federal Legislation

Senate Passes First Set of FY2024 Appropriations Bills

• On March 8, the Senate passed the first set of FY2024 appropriations bills that included FDA spending and a lean package of healthcare payment patches and extenders, most of which expire in December 2024. The health package that was passed included a partial fix for the Medicare physician pay cut, an extension to Advanced Alternative Payment Model bonuses, and a continuation of disproportionate share hospital and community health center funding, along with other policies while omitting pharmacy benefit manager reform, site-neutral and transparency pricing provisions, and a full reauthorization of the pandemic and opioid response laws. Congress must pass the second round of FY2024 appropriations bills before March 22, which will include funding for HHS (Inside Health Policy, March 8; Modern Healthcare, March 6).

House Committee Votes to Stop CMS Nursing Home Staffing Mandates

• On March 6, the House Ways and Means Committee voted to extend the Protecting American Seniors’ Access to Care Act of 2023 with a 26-17 vote, which would block CMS’ proposed rule mandating minimum nursing home staffing standards. Party viewpoints are split, with Republicans perceiving the CMS mandate as costly and impractical, while Democrats believe it will aid in improving the quality of care in nursing homes (Modern Healthcare, March 6).

Biden Expresses Support for Drug Pricing Controls and Affordable Care Act Subsidies

• During President Biden’s State of the Union address last week, he proposed expanding the Medicare drug negotiations over the next decade to include 500 drugs, expanding the $2,000 cap on drugs and $35 cap on insulin to all plans. He also proposed to make permanent the enhanced Affordable Care Act (ACA) subsidies. Some stakeholders expressed support for his policies, such as the AARP and the Association of Community Affiliated Plans (ACAP). However, the pharmaceutical industry along with the Council for Affordable Health Coverage expressed concerns about the Inflation Reduction Act and the proposed policy changes. Additionally, Republicans in the House Budget Committee have advanced a 2025 Budget Resolution that does not align with Biden’s policies and proposes repealing drug price negotiation and the enhanced ACA subsidies as well as supporting policies to allow Medicaid work requirements (Inside Health Policy, March 8).