Wednesday, June 20, 2018

New MACPAC Report on Medicaid

The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2018 Report to the Congress. Click here to access a copy of the report, which focuses on the following topic areas:

the high cost of prescription drugs;
the opioid epidemic; and
the growing trend of delivering long term services and supports (LTSS) through managed care.

MACPAC issues these reports to inform policymakers, and their topic selection indicates opioid epidemic and Medicaid managed LTSS are hot topics for Medicaid right now.

The first chapter on barriers to substance use disorder (SUD) treatment makes two recommendations to support information exchange among health care providers under the federal SUD confidentiality regulations known as Part 2. Part 2 has been criticized as confusing, restrictive, and challenging to implement; according to the Commission, additional guidance, education, and technical assistance to clarify these regulations would be a meaningful step to help providers, payers, and patients understand their legal rights and obligations and opportunities for information sharing that would facilitate integration of care.

Another chapter on barriers to SUD treatment builds on MACPAC’s June 2017 analysis, Medicaid and the Opioid Epidemic. The new analysis finds that although states already can cover many clinical SUD services, only 12 states pay for the full continuum. And while the institutions for mental diseases (IMD) exclusion often is cited as a barrier to paying for residential services, states can cover residential services under some conditions now through Section 1115 demonstrations and managed care. Eliminating the IMD exclusion would not address other coverage gaps or low participation of SUD treatment providers in Medicaid.

MACPAC also reflects on Medicaid’s role as the nation’s largest payer for LTSS and the growing trend to deliver these services through managed care. While states typically adopt managed LTSS (MLTSS) after gaining experience with managed care for acute care, the complex needs of people who receive LTSS and the wide range of services they use make implementation of MLTSS more complex. The Commission observes that adoption of new quality measures and efforts to improve encounter data have potential to improve evaluation and oversight activities.

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