• Medicaid is the largest payer for long-term services and supports (LTSS), including post-acute care, covering approximately 60% of such services in the United States
• Org leaders who service Medicaid patients must understand policymakers’ attitudes toward the program. Those attitudes may be changing with a new administration and Congress.

On Thursday, March 13^th, the Medicaid and CHIP Payment and Access Commission (MACPAC) released its semi-annual report. The report included three chapters and five recommendations. Below we provide a summary of each chapter and the associated recommendations with an emphasis on applicability to home care services.

Due to the care the Alliance puts into its policy analysis and communication, our coverage of the MACPAC report is lengthier than most of our articles. Accordingly, we will split it in two to make it easier for organizational leaders to digest.

Part 1 will cover Chapter one of the MACPAC report. Part 2 will cover chapters two and three.

Chapter 1: External Quality Review in Medicaid Managed Care

Over 70% of beneficiaries are enrolled in managed care for at least a portion of their Medicaid services, including a growing number of states that include home and community-based services as part of the managed care offerings. Every state utilizing managed care must contract with an independent organization to perform an annual external quality review (EQR) of each plan participating in their program. The EQR is a core component of Medicaid managed care plan oversight. EQR Organizations must perform and report on validation of performance improvement projects and performance measures; plan compliance with enrollee rights, disenrollment limitations, and emergency and post-stabilization service requirements; and network adequacy requirements. States can also include optional activities regarding validation of encounter data, validating consumer and provider surveys, calculating performance measures, and calculating performance measures, among other activities.

In the March report, MACPAC makes three recommendations regarding to the EQR process:

• Require the EQR annual technical report include outcomes data and results from quantitative assessments collected and reviewed;
• Update EQR protocols to:
  • Reduce areas of duplication with other federal quality and oversight reporting requirements;
  • Create a more standardized structure in the annual technical report that summarizes EQR activities, results, and actions taken by state Medicaid agencies; and
  • Identify key takeaways on plan performance.
• Require states to publish the annual EQR technical reports in a 508-compliant format and for CMS to publicly post all state EQR reports in a central repository on the CMS website.

While none of these recommendations specifically applies to HCBS and home care, there are opportunities to leverage the EQR framework to further improve oversight of plans and ensure appropriate, quality, services to individuals. Specifically the EQR process could be used to strengthen HCBS-specific performance improvement projects and to evaluate prior authorization practices in post-acute care and HCBS.

The full MACPAC March Report is available online HERE.

Please see the Alliance analysis of chapters two and three of the MACPAC report HERE.