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September 2019 Public Meeting

The September meeting opened with a review of a draft of MACPAC’s January 2020 report to Congress on state oversight of institutions for mental diseases. This is the second of two studies assigned by the SUPPORT for Patients and Communities Act; MACPAC will issue its congressionally mandated review of state Medicaid utilization management policies on medication-assisted treatment in October 2019.

The Commission then turned its attention to Medicaid managed care with a session on directed payments, a new option created in the 2016 managed care rule similar to fee-for-service supplemental payments. The final session of the morning addressed the implementation status of requirements that take effect in March 2022 for settings that provide home- and community-based services.

After lunch, the Commission reviewed national and state-level data documenting declines in Medicaid and CHIP enrollment, the first enrollment declines since implementation of the Patient Protection and Affordable Care Act. In the next session, the Commission reviewed proposed changes that affect confidentiality of medical records of patients with substance use disorder, examining regulatory changes that the Substance Abuse and Mental Health Administration has proposed.

Then, after a brief break, MACPAC staff presented findings from the Commission’s analysis of the effects of drug formularies on utilization and spending in Medicaid and how this compares to other payers. The final session on Thursday addressed issues related to nursing facility payment.

MACPAC’s Friday agenda featured two sessions on integration of care for people who are dually eligible for Medicaid and Medicare. The meeting opened with a panel on federal and state integration efforts, featuring Tim Engelhardt, director of the Medicare-Medicaid Coordination Office at the Centers for Medicare & Medicaid Services (CMS); Bea Rector, director of the Home and Community Services Division in Washington State; and Matt Wimmer, Medicaid director in Idaho.* The meeting concluded with a discussion of the Commission’s potential future work in this area.

* Panelists’ presentations did not include slides.


  1. IMD ADDITIONAL INFO Act: Review of Draft Report on State Oversight of Institutions for Mental Diseases
  2. Use and Oversight of Directed Payments in Medicaid Managed Care
  3. Home- and Community-Based Services Settings Rule: Status of Implementation
  4. Medicaid and CHIP Enrollment: Analysis of National and State Trends
  5. Proposed Rule Affecting Confidentiality of Substance Use Disorder Patient Records (42 CFR Part 2)
  6. Findings from Phase 2 of Analysis on Medicaid Drug Formularies: Effects on Utilization and Spending
  7. Nursing Facility Payment Policy: Payment Methods and Recent Developments
  8. Presentation of Integrated Care Work Plan and Further Discussion