Medicaid, CHIP payments to be reviewed by new federal commission
■ The panel's chair expects the body to serve as a MedPAC for Medicaid.
By Doug Trapp — Posted Jan. 25, 2010
Washington -- A newly appointed commission will examine how Medicaid physician pay affects access to care by Medicaid patients and those in the Children's Health Insurance Program, among other issues.
The Medicaid and CHIP Payment and Access Commission, or MACPAC, will be chaired by Diane Rowland, ScD, executive director of the Kaiser Commission on Medicaid and the Uninsured. The U.S. comptroller general appointed the panel's 17 members Dec. 23, 2009.
MACPAC was created by a provision of the Children's Health Insurance Program Reauthorization Act, signed by President Obama in February 2009. The act instructs the panel to examine the effect of Medicaid pay and other factors on the access and quality of care received by Medicaid and CHIP enrollees.
"It's clearly one of the things that Congress put in specifically that they would like to have looked at," Rowland said. MACPAC also will examine the impact of Medicaid and CHIP policies on the health system as a whole. She expects the panel will investigate access to pediatric specialists and state disparities in access to care.
MACPAC does not yet have federal funding. However, the national health system reform bills would provide at least $11 million for the commission to hire a staff and carry out its mandate. MACPAC board members will not be paid a salary.
Rowland -- who will retain her position on the Kaiser commission -- expects MACPAC to advise Congress on Medicaid, as the Medicare Payment Advisory Commission does for Medicare. Rowland said MACPAC could serve a critical role if Congress adopts a health reform bill with a provision to cover a projected 15 million additional people -- mostly adults -- in Medicaid over a decade.
Four physicians will serve on MACPAC. They include its vice chair, David N. Sundwall, MD, a family physician and executive director of the Utah Dept. of Health. Dr. Sundwall said he wants to examine how to improve public health through Medicaid and CHIP. The programs could, for example, strengthen incentives for pregnant women to obtain prenatal care, he said.
Another physician on the panel said he hopes to advise Congress on how best to use technology to improve the delivery of care in Medicaid and CHIP. Steven Waldren, MD, director of the center for health information technology at the American Academy of Family Physicians, said making Medicaid less bureaucratic and easier to participate in is also important. "It's not all about the money."
Rowland, Dr. Sundwall and Dr. Waldren acknowledged the possibility that Congress might ignore MACPAC's recommendations because of politics or budget concerns. That's why the commission has to make "recommendations that can be acted on," Dr. Waldren said.
Rowland said Congress asked for MACPAC, so hopefully lawmakers will listen to the panel. "The advantage that this group has is they have a reporting relationship to Congress."
MACPAC -- unlike previous Medicaid panels -- is permanent and has a strong list of members, said Jocelyn Guyer, co-executive director of the Georgetown Center for Children and Families at Georgetown University's Health Policy Institute in Washington, D.C. That should increase the importance of the commission's reports, she said.
American Medical Association policy supports a federal Medicaid committee to advise the Centers for Medicare & Medicaid Services and Congress on program policies that impact physicians and patients.