MACPAC Discusses Directed Payments, Continuous Eligibility, MOUD

The Medicaid and CHIP Payment and Access Commission (MACPAC) met Oct. 31 and Nov. 1 to discuss a variety of topics including directed payments in Medicaid managed care, medications for opioid use disorder (MOUD), continuous eligibility for children, and managed care external quality review (EQR) policy options.In the Oct. 31 sessions, MACPAC discussed the various federal policies regarding MOUD and additional factors that limit access including provider availability, cost, stigma, and utilization management. The commission plans to share additional findings related to MOUD utilization and effects of the MOUD benefit mandate in their June report. Additionally, the commissioners heard from a panel on Multi-Year Continuous Eligibility for Children regarding key program and policy considerations including insights from Oregon's program.

In the Nov. 1 sessions, MACPAC discussed its analysis of EQRs to identify challenges and limitations and discussed policy options to address these challenges for possible recommendations during its December meeting. Policy options included a requirement for annual technical reports to include outcomes data and results from quantitative assessments of EQRs, additional guidance and protocols from the Centers for Medicare & Medicaid Services to ensure more prescriptive and consistent standards for reporting on EQR activities, and improvement in accessibility of EQR findings by publicly posting annual technical reports.

Lastly, the commission reviewed an analysis of directed payments, which found several trends and characteristics. These included growth in use and spending of directed payments, targeting to hospitals and behavioral health providers, financing through provider taxes or intergovernmental transfers, differences in payment methods, and a common goal of improving access through directed payments. Commissioners discussed additional information needs to evaluate directed payments and understand the adequacy of Medicaid payments. As a next step, the commission with continue to build on its work by reviewing upper payment limit narratives and directed payment arrangements as well as updating a payment index comparing Medicaid hospital payments across states to Medicare payment rates.