Patient Protection and Affordable Care Act/Title II/Subtitle J

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Subtitle J—Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC)[edit]

SEC. 2801. MACPAC ASSESSMENT OF POLICIES AFFECTING ALL MEDICAID BENEFICIARIES.[edit]

(a) In General- Section 1900 of the Social Security Act (42 U.S.C. 1396) is amended--
(1) in subsection (b)--
(A) in paragraph (1)--
(i) in the paragraph heading, by inserting `FOR ALL STATES' before `AND ANNUAL'; and
(ii) in subparagraph (A), by striking `children's';
(iii) in subparagraph (B), by inserting `, the Secretary, and States' after `Congress';
(iv) in subparagraph (C), by striking `March 1' and inserting `March 15'; and
(v) in subparagraph (D), by striking `June 1' and inserting `June 15';
(B) in paragraph (2)--
(i) in subparagraph (A)--
(I) in clause (i)--
(aa) by inserting `the efficient provision of' after `expenditures for'; and
(bb) by striking `hospital, skilled nursing facility, physician, Federally-qualified health center, rural health center, and other fees' and inserting `payments to medical, dental, and health professionals, hospitals, residential and long-term care providers, providers of home and community based services, Federally-qualified health centers and rural health clinics, managed care entities, and providers of other covered items and services'; and
(II) in clause (iii), by inserting `(including how such factors and methodologies enable such beneficiaries to obtain the services for which they are eligible, affect provider supply, and affect providers that serve a disproportionate share of low-income and other vulnerable populations)' after `beneficiaries';
(ii) by redesignating subparagraphs (B) and (C) as subparagraphs (F) and (H), respectively;
(iii) by inserting after subparagraph (A), the following:
`(B) ELIGIBILITY POLICIES- Medicaid and CHIP eligibility policies, including a determination of the degree to which Federal and State policies provide health care coverage to needy populations.
`(C) ENROLLMENT AND RETENTION PROCESSES- Medicaid and CHIP enrollment and retention processes, including a determination of the degree to which Federal and State policies encourage the enrollment of individuals who are eligible for such programs and screen out individuals who are ineligible, while minimizing the share of program expenses devoted to such processes.
`(D) COVERAGE POLICIES- Medicaid and CHIP benefit and coverage policies, including a determination of the degree to which Federal and State policies provide access to the services enrollees require to improve and maintain their health and functional status.
`(E) QUALITY OF CARE- Medicaid and CHIP policies as they relate to the quality of care provided under those programs, including a determination of the degree to which Federal and State policies achieve their stated goals and interact with similar goals established by other purchasers of health care services.';
(iv) by inserting after subparagraph (F) (as redesignated by clause (ii) of this subparagraph), the following:
`(G) INTERACTIONS WITH MEDICARE AND MEDICAID- Consistent with paragraph (11), the interaction of policies under Medicaid and the Medicare program under title XVIII, including with respect to how such interactions affect access to services, payments, and dual eligible individuals.' and
(v) in subparagraph (H) (as so redesignated), by inserting `and preventive, acute, and long-term services and supports' after `barriers';
(C) by redesignating paragraphs (3) through (9) as paragraphs (4) through (10), respectively;
(D) by inserting after paragraph (2), the following new paragraph:
`(3) RECOMMENDATIONS AND REPORTS OF STATE-SPECIFIC DATA- MACPAC shall--
`(A) review national and State-specific Medicaid and CHIP data; and
`(B) submit reports and recommendations to Congress, the Secretary, and States based on such reviews.';
(E) in paragraph (4), as redesignated by subparagraph (C), by striking `or any other problems' and all that follows through the period and inserting `, as well as other factors that adversely affect, or have the potential to adversely affect, access to care by, or the health care status of, Medicaid and CHIP beneficiaries. MACPAC shall include in the annual report required under paragraph (1)(D) a description of all such areas or problems identified with respect to the period addressed in the report.';
(F) in paragraph (5), as so redesignated,--
(i) in the paragraph heading, by inserting `AND REGULATIONS' after `REPORTS'; and
(ii) by striking `If' and inserting the following:
`(A) CERTAIN SECRETARIAL REPORTS- If'; and
(iii) in the second sentence, by inserting `and the Secretary' after `appropriate committees of Congress'; and
(iv) by adding at the end the following:
`(B) REGULATIONS- MACPAC shall review Medicaid and CHIP regulations and may comment through submission of a report to the appropriate committees of Congress and the Secretary, on any such regulations that affect access, quality, or efficiency of health care.';
(G) in paragraph (10), as so redesignated, by inserting `, and shall submit with any recommendations, a report on the Federal and State-specific budget consequences of the recommendations' before the period; and
(H) by adding at the end the following:
`(11) CONSULTATION AND COORDINATION WITH MEDPAC-
`(A) IN GENERAL- MACPAC shall consult with the Medicare Payment Advisory Commission (in this paragraph referred to as `MedPAC') established under section 1805 in carrying out its duties under this section, as appropriate and particularly with respect to the issues specified in paragraph (2) as they relate to those Medicaid beneficiaries who are dually eligible for Medicaid and the Medicare program under title XVIII, adult Medicaid beneficiaries (who are not dually eligible for Medicare), and beneficiaries under Medicare. Responsibility for analysis of and recommendations to change Medicare policy regarding Medicare beneficiaries, including Medicare beneficiaries who are dually eligible for Medicare and Medicaid, shall rest with MedPAC.
`(B) INFORMATION SHARING- MACPAC and MedPAC shall have access to deliberations and records of the other such entity, respectively, upon the request of the other such entity.
`(12) CONSULTATION WITH STATES- MACPAC shall regularly consult with States in carrying out its duties under this section, including with respect to developing processes for carrying out such duties, and shall ensure that input from States is taken into account and represented in MACPAC's recommendations and reports.
`(13) COORDINATE AND CONSULT WITH THE FEDERAL COORDINATED HEALTH CARE OFFICE- MACPAC shall coordinate and consult with the Federal Coordinated Health Care Office established under section 2081 of the Patient Protection and Affordable Care Act before making any recommendations regarding dual eligible individuals.
`(14) PROGRAMMATIC OVERSIGHT VESTED IN THE SECRETARY- MACPAC's authority to make recommendations in accordance with this section shall not affect, or be considered to duplicate, the Secretary's authority to carry out Federal responsibilities with respect to Medicaid and CHIP.';
(2) in subsection (c)(2)--
(A) by striking subparagraphs (A) and (B) and inserting the following:
`(A) IN GENERAL- The membership of MACPAC shall include individuals who have had direct experience as enrollees or parents or caregivers of enrollees in Medicaid or CHIP and individuals with national recognition for their expertise in Federal safety net health programs, health finance and economics, actuarial science, health plans and integrated delivery systems, reimbursement for health care, health information technology, and other providers of health services, public health, and other related fields, who provide a mix of different professions, broad geographic representation, and a balance between urban and rural representation.
`(B) INCLUSION- The membership of MACPAC shall include (but not be limited to) physicians, dentists, and other health professionals, employers, third-party payers, and individuals with expertise in the delivery of health services. Such membership shall also include representatives of children, pregnant women, the elderly, individuals with disabilities, caregivers, and dual eligible individuals, current or former representatives of State agencies responsible for administering Medicaid, and current or former representatives of State agencies responsible for administering CHIP.'.
(3) in subsection (d)(2), by inserting `and State' after `Federal';
(4) in subsection (e)(1), in the first sentence, by inserting `and, as a condition for receiving payments under sections 1903(a) and 2105(a), from any State agency responsible for administering Medicaid or CHIP,' after `United States'; and
(5) in subsection (f)--
(A) in the subsection heading, by striking `Authorization of Appropriations' and inserting `Funding';
(B) in paragraph (1), by inserting `(other than for fiscal year 2010)' before `in the same manner'; and
(C) by adding at the end the following:
`(3) FUNDING FOR FISCAL YEAR 2010-
`(A) IN GENERAL- Out of any funds in the Treasury not otherwise appropriated, there is appropriated to MACPAC to carry out the provisions of this section for fiscal year 2010, $9,000,000.
`(B) TRANSFER OF FUNDS- Notwithstanding section 2104(a)(13), from the amounts appropriated in such section for fiscal year 2010, $2,000,000 is hereby transferred and made available in such fiscal year to MACPAC to carry out the provisions of this section.
`(4) AVAILABILITY- Amounts made available under paragraphs (2) and (3) to MACPAC to carry out the provisions of this section shall remain available until expended.'.
(b) Conforming MedPAC Amendments- Section 1805(b) of the Social Security Act (42 U.S.C. 1395b-6(b)), is amended--
(1) in paragraph (1)(C), by striking `March 1 of each year (beginning with 1998)' and inserting `March 15';
(2) in paragraph (1)(D), by inserting `, and (beginning with 2012) containing an examination of the topics described in paragraph (9), to the extent feasible' before the period; and
(3) by adding at the end the following:
`(9) REVIEW AND ANNUAL REPORT ON MEDICAID AND COMMERCIAL TRENDS- The Commission shall review and report on aggregate trends in spending, utilization, and financial performance under the Medicaid program under title XIX and the private market for health care services with respect to providers for which, on an aggregate national basis, a significant portion of revenue or services is associated with the Medicaid program. Where appropriate, the Commission shall conduct such review in consultation with the Medicaid and CHIP Payment and Access Commission established under section 1900 (in this section referred to as `MACPAC').
`(10) COORDINATE AND CONSULT WITH THE FEDERAL COORDINATED HEALTH CARE OFFICE- The Commission shall coordinate and consult with the Federal Coordinated Health Care Office established under section 2081 of the Patient Protection and Affordable Care Act before making any recommendations regarding dual eligible individuals.
`(11) INTERACTION OF MEDICAID AND MEDICARE- The Commission shall consult with MACPAC in carrying out its duties under this section, as appropriate. Responsibility for analysis of and recommendations to change Medicare policy regarding Medicare beneficiaries, including Medicare beneficiaries who are dually eligible for Medicare and Medicaid, shall rest with the Commission. Responsibility for analysis of and recommendations to change Medicaid policy regarding Medicaid beneficiaries, including Medicaid beneficiaries who are dually eligible for Medicare and Medicaid, shall rest with MACPAC.'.