The Medicaid and CHIP Payment and Access Commission (MACPAC) has outlined its agenda for the 2024-2025 meeting cycle, highlighting several topics that are particularly relevant to home health providers. These discussions focus on improving accountability, payment, and efficiency in Medicaid services, specifically related to home- and community-based care. Key areas of interest include:

• Self-Directed Home- and Community-Based Services (HCBS): MACPAC is reviewing how states design and manage self-directed HCBS programs, which allow Medicaid recipients to have greater control over their care. The Commission will also address barriers to self-direction, providing valuable resources for policymakers and home health providers involved in these models.
• Managed Care Accountability: With nearly 75% of Medicaid recipients enrolled in managed care, accountability is a major focus. MACPAC will explore how states and the Centers for Medicare & Medicaid Services (CMS) ensure that managed care organizations (MCOs) meet performance standards, using tools like external quality reviews to improve service quality and compliance.
• Automation in Prior Authorization: MACPAC is expanding its review of automated prior authorization processes in Medicaid, focusing on the use of technology, including artificial intelligence, to streamline decision-making. Earlier this year, MACPAC made recommendations to improve managed care denials and appeals processes and issued a brief on how prior authorization works. The Commission will now delve deeper into how widespread prior authorization is, its challenges, and how states and MCOs are using technology to simplify the process, which could help home health providers by reducing delays in service approvals.
• HCBS Payment: To address the ongoing HCBS workforce shortage, MACPAC is reviewing financial and non-financial strategies used by states and managed care plans. This includes evaluating how the rate certification process can ensure fair and adequate payment, an important issue for home health providers who rely on a strong HCBS workforce.

Home health providers are encouraged to attend MACPAC’s public meetings to stay informed on key Medicaid policy discussions and provide input through public comments. However, rest assured that HCAF will be actively participating and will keep members updated on advocacy opportunities as they arise.

For more information, including the meeting schedule and registration details, please click here.