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January 2019 Public Meeting

Hospital payment was a key focus of MACPAC’s January meeting with the Commission voting on Thursday to approve two sets of recommendations, the first addressing the structure of disproportionate share hospital (DSH) allotment reductions and the second directed to improving compliance with upper payment limit requirements. Both sets of recommendations are slated for inclusion in MACPAC’s March 2019 Report to Congress on Medicaid and CHIP.

Later that morning, the Commission discussed a study on performance and return on investment for state program integrity strategies. This session was originally scheduled for the December meeting. Following a break for lunch, the Commission was briefed on a new report by Mathematica Policy Research, under contract to MACPAC, regarding beneficiary enrollment in the Financial Alignment Initiative, which is testing new approaches to integrating care for people who are dually eligible for Medicaid and Medicare. Later, staff presented an analysis of the factors affecting physician decisions to accept new Medicaid patients.

Friday’s sessions opened with a panel of experts discussing how utilization management policies are applied to medication-assisted treatment (MAT). Under the SUPPORT for Patients and Communities Act (P.L. 115-271), MACPAC is required to study utilization management policies related to MAT and report on these by late October 2019. The meeting concluded with its third and final session on hospital payment: how to account for third-party payments in the DSH definition of Medicaid shortfall.


  1. Improving the Structure of Disproportionate Share Hospital Allotment Reductions: Review of Draft Chapter and Recommendations for the March 2019 Report
  2. Upper Payment Limit Compliance: Review of Draft Recommendations in the March 2019 Report
  3. Measuring Performance and Return on Investment for Program Integrity Strategies
  4. Factors Affecting Beneficiary Enrollment in the Financial Alignment Initiative
  5. Physician Acceptance of New Medicaid Patients: New Findings
  6. Utilization Management of Medication-Assisted Treatment
  7. Accounting for Third-Party Payments in the Disproportionate Share Hospital Definition of Medicaid Shortfall