Its authority to exist has been established and the members have been chosen, but a key ingredient is missing for the Medicaid and CHIP Payment and Access Commission to start doing business: money.
Ready ... set ... wait
MACPAC in a holding pattern while waiting for budget approval
The 17-member panel, known as MACPAC, was established as part of the Children’s Health Insurance Program Reauthorization Act of 2009, or CHIPRA, with a charge to review Medicaid and CHIP access and payment policies and make recommendations to Congress on issues that affect these programs.
The commission was supposed to get under way early this year but its newly appointed chairwoman said an absence of funding from the federal government has cast the new advisory commission into a “watchful waiting period.”
“We have the authority to exist from CHIPRA, but there’s no appropriations” to jump-start any of the panel’s scheduled activities, said the chairwoman, Diane Rowland, executive vice president of the Henry J. Kaiser Family Foundation and executive director of the Kaiser Commission on Medicaid and the Uninsured.
“I think we have a wonderful set of commission members that have been appointed, and we’re anxious to start the task of the commission,” Rowland said. As of now, “there’s no ability to secure space or hire staff or schedule a meeting at this point. So, we’re awaiting a budget so the commission can convene.”
Where that budget will come from is unclear. The Government Accountability Office is the organization that holds jurisdiction over federal advisory panels such as MACPAC and the Medicare Payment Advisory Commission. Members of the new MACPAC were announced late last year, which included Rowland and a number of hospital and physician industry representatives such as Steven Waldren, the director of the American Academy of Family Physicians’ Center for Health Information Technology; Patricia Gabow, CEO of Denver Health; and Herman Gray, president of Children’s Hospital of (Detroit) Michigan and senior vice president of Children’s parent Detroit Medical Center.
The MACPAC has had its critics, Gray acknowledged: “There have been concerns at the state level that this commission would be making decisions that could impose upon the states.” Even so, he said he doubted that a conspiracy to dismantle the advisory panel was the reason behind the absence of funds. “I don’t think it has enough visibility for the politicians to conspire against us,” Gray said.
“I’d be happy if a source of funding was found anyplace,” Gray said. “Creating a MACPAC would be a positive thing, and I look forward to serving if we ever get the opportunity to.”
As a pediatrician and children’s hospital president, “I think there are lots of things to talk about in improving the health of children, and I’m hopeful the MACPAC will have the opportunity to do that. Medicaid is a huge payer in the United States and to have 50 programs vary in so many ways” should be enough of a reason to seek improvements to the program, he said.
The absence of a health reform bill shouldn’t be an excuse not to proceed with MACPAC, Gray continued. “The fact that we don’t have a health reform bill and lack of clarity on that issue, doesn’t mean we shouldn’t be committed to reform.”
Some $11 million in fact had been earmarked for MACPAC in the respective House and Senate healthcare reform bills, Rowland said. But with health reform in limbo, “another vehicle has to be found.”
GAO was also at a loss for answers on the panel’s fate. “Whether provisions for funding for MACPAC will survive” in the event a new reform bill is crafted, or whether some other legislative vehicle can be found, is unknown, said Bruce Steinwald, an adviser to the GAO.
Some commissioners hold out hope that CMS administrative funds will be made available to pay for the commission’s activities. Others say the money is unlikely to come directly from the White House.
Seeing an absence of funds for MACPAC in the president’s fiscal 2011 budget request, Larry Gage, president of the National Association of Public Hospitals and Health Systems, speculated that President Barack Obama “is leaving it to Congress to fund it.”
“Its members are appointed by GAO, so in that sense it’s a creature of the legislative and not the executive branch,” he said.
For now, the commission appears to be “stalled in the snow,” which is an unfortunate development for safety net hospitals that derive 75% to 85% of their revenue from Medicaid, Gage said.
Medicaid is a very fragmented program, “and it’s suffered quite a bit, not having the same level of attention that Medicare has enjoyed from MedPAC,” Gage said.
Children eligible for this program aren’t signing up and provider payments aren’t always adequate in every state, which raises concerns about access to care and getting enough providers to participate in the program, he said.
As a result, many gaps have formed in Medicaid coverage around the country, Gage said. “Our safety net hospitals try to fill those gaps, but in some cases they’re cutting back on outpatient pharmacies or trauma care, because their principal payer, Medicaid, isn’t paying what it needs to pay. These are all issues that could be addressed by this commission.”
Waldren, one of the appointed commissioners and a family physician, agreed that physicians take a “financial hit” for taking care of Medicaid patients. “We can only take care of so many of these patients, so there’s a big need for this commission to improve the Medicaid services we provide.”
Making it easier for physicians to participate in Medicaid is another pressing concern the commission needs to address, Waldren said. Drawing from his own experiences, Waldren said it’s often a big administrative hassle for doctors to deal with Medicaid.
The commission would also be able to help practices from a health information technology standpoint, Waldren said. The issuance of regulations allowing physicians to tap into federal funds for using electronic health records “will have a large impact on practices in terms of thinking about expanding the Medicaid services they offer,” he said.
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