In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Memhet Oz, MACPAC offered comments on a notice of proposed rulemaking on Medicaid managed care state directed payments (SDPs) and fee-for-service (FFS) targeted practitioner payments.
The Commission supports efforts to ensure that Medicaid payments are consistent with the statutory principles of economy, efficiency, access, and quality. However, the Commission expressed concerns that the proposed application of the Medicare-based limits on SDPs and targeted FFS practitioner payments at the service level may limit states’ flexibility to use payment policy to achieve policy goals of access and quality.
In the letter, the Commission noted that Medicare payment rates are not designed to support the different populations covered under Medicaid, such as children and pregnant women, and that applying payment limits at the service level can restrict states’ flexibility to design payment rates and methods that support policy goals of access or quality. The Commission encouraged CMS to consider providing states with additional flexibility in developing payment rates.