MACPAC Summary, Part 1

• Meeting Addresses Managed Care Oversight, Self-Direction
• READ Part 2 of our MACPAC Summary HERE
• READ our MedPAC Summary HERE

On December 12-13, the Medicaid and CHIP Payment and Access Commission (MACPAC) held their monthly convening. Several sessions were of relevance to the home care community, including managed care oversight, self-direction in home and community-based services (HCBS), findings from an extensive analysis of HCBS spending and utilization patterns, and findings on Medicaid payment policies that support the HCBS workforce.

The first session of the meeting addressed ‘State and Federal Tools for Ensuring Accountability of Medicaid Managed Care Organizations.’ This session discussed requirements and options for oversight of Medicaid managed care organizations (MCOs) and tools for states to ensure plan compliance. Important items from the discussion included:

• The Assessment and Improvement Strategy (QAPI): states must establish a QAPI to guide MCO activities, including defined performance measures and monitoring procedures;
• Options to include special contract provisions including incentives, withholds, and risk-sharing mechanisms
• Requirement for contracts to include sanctions provisions, including reasons why state may impose and type of sanctions, which may include:
  • Civil monetary penalties
  • Appointment of temporary management of an MCO
  • Granting enrollees right to terminate enrollment
  • Suspension of new enrollment
  • Suspension of payment for beneficiaries enrolled after effective date of sanction; until no longer required
• A review of state contracts to identify the most common strategies, which found:
  • Monetary penalties (40 states utilized)
  • Corrective action plans and contract termination (38)
  • Administrative/corrective actions (32)
  • Enrollment penalties (24)
  • Capitation payment penalties (21)
• A review of state procurement strategies to understand how states competitively selected plans.

Commissioners discussed the oversight of managed care entities and were specifically interested in whether there were ways to link specific strategies with improved outcome measures, such as HEDIS scores. Although managed long-term services and supports (MLTSS) was not specifically discussed in the session, the tools and strategies apply across all services in managed care.

In the afternoon, commissioners heard a presentation from MACPAC staff on children with special needs transitioning to adult care. In Medicaid, there are many different eligibility policies and service requirements for children and adults. When children with special needs age into adult services, there can be challenges with maintaining Medicaid eligibility and, especially, with continuity of care due to the end of EPSDT coverage. Commission staff discussed a variety of issues including:

• Lack of communication and planning regarding the changes;
• Lack of coordination across agencies;
• Lack of measurement on outcomes.

Staff presented several potential recommendations for discussion, though none were voted on. Additional information will likely be brought forward in future meetings leading to formal recommendations.

Later in the afternoon of the 12^th, the commission spent significant time discussing self-direction in HCBS, with both an overview of state programs and policies as well as a panel of consumers, family members, and state officials. Key takeaways from the overview of state programs were:

• Every state allows older adults (age 65+) and adults with physical disabilities to self-direct;
• Over 90 percent of states include self-direction for adults with intellectual/ developmental disabilities (I/DD) and 86 percent of states offer self-direction for children with I/DD;
• Adults with serious mental illness services include self-direction options in less than half of states;
• Over 50 percent of self-directing individuals hire a relative or someone they know.

Again, no specific recommendations were discussed but the overall sentiment of commissioners and panelists was positive. MACPAC staff indicated that they would be holding interviews with states and other stakeholders that would be covered in 2025 sessions.

Further information about the sessions and slides from the presentations are available HERE.