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

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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.

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4 physicians on new Medicaid commission

Four of the 17 members of the Medicaid and CHIP Payment and Access Commission are physicians. The commission will examine access to and quality of care provided by Medicaid and the Children's Health Insurance Program.

First term ending December 2012

  • Diane Rowland, ScD, executive director, Kaiser Commission on Medicaid and the Uninsured (serving as MACPAC chair)
  • Donna Checkett, senior vice president of Medicaid business development, Aetna
  • Patricia Gabow, MD, CEO of Denver Health and Hospital Authority
  • Mark Hoyt, national practice leader of the Government Human Services Consulting Specialty Group, Mercer, LLC
  • Trish Riley, director, Maine governor's Office of Health Policy and Finance
  • Steven Waldren, MD, director, Center for Health Information Technology, American Academy of Family Physicians

First term ending December 2011

  • David Sundwall, MD, executive director, Utah Dept. of Health, Utah commissioner of health (MACPAC vice chair)
  • Richard Chambers, CEO of CalOptima
  • Burton Edelstein, DDS, MPH, clinical dentistry professor, College of Dental Medicine and Clinical Health Policy and Management, Mailman School of Public Health, Columbia University, New York
  • Denise Henning, service line leader for women's health, Collier Health Services, Florida
  • Judith Moore, senior fellow, National Health Policy Forum, George Washington University, Washington, D.C.
  • Robin Smith, foster and adoptive parent of special needs children enrolled in Medicaid

First term ending December 2010

  • Sharon L. Carte, executive director, West Virginia Children's Health Insurance Program
  • Andrea Cohen, director of health services, New York City Office of the Deputy Mayor for Health and Human Services
  • Herman Gray, MD, president, Children's Hospital of Michigan; senior vice president, Detroit Medical Center
  • Norma Martinez Rogers, PhD, RN, professor, Dept. of Family Nursing, University of Texas Health Science Center at San Antonio; president of the National Assn. of Hispanic Nurses
  • Sara Rosenbaum, chair, Dept. of Health Policy and Harold and Jane Hirsh Professor of Health Law and Policy, George Washington University School of Public Health and Health Services; professor of Health Care Sciences, George Washington University School of Medicine and Health Sciences, Washington, D.C.

Source: Government Accountability Office, December 2009 (link)

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