42 U.S.
Code § 1396 - Medicaid and CHIP Payment and Access Commission
(a)
Establishment
There is hereby established the Medicaid
and CHIP Payment and Access Commission (in this section referred to as “MACPAC”).
(b) Duties
(1) Review of access policies for all
States and annual reports
MACPAC shall—
(A) review policies of the Medicaid
program established under this subchapter (in this section referred to as
“Medicaid”) and the State Children’s Health Insurance Program established under
subchapter XXI (in this section referred to as “CHIP”) affecting access to
covered items and services, including topics described in paragraph (2);
(B) make recommendations to Congress,
the Secretary, and States concerning such access policies;
(C) by not later than March 15 of each
year (beginning with 2010), submit a report to Congress containing the results
of such reviews and MACPAC’s recommendations concerning such policies; and
(D) by not later than June 15 of each
year (beginning with 2010), submit a report to Congress containing an
examination of issues affecting Medicaid and CHIP, including the implications
of changes in health care delivery in the United States and in the market for
health care services on such programs.
(2) Specific topics to be reviewed
Specifically, MACPAC shall review and
assess the following:
(A) Medicaid and CHIP payment policies
Payment policies under Medicaid and
CHIP, including—
(i) the factors affecting expenditures
for the efficient provision of items and services in different sectors,
including the process for updating 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;
(ii) payment methodologies; and
(iii) the relationship of such factors
and methodologies to access and quality of care for Medicaid and CHIP beneficiaries
(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).
(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.
(F) Interaction of Medicaid and CHIP
payment policies with health care delivery generally
The effect of Medicaid and CHIP payment
policies on access to items and services for children and other Medicaid and
CHIP populations other than under this subchapter or subchapter XXI and the
implications of changes in health care delivery in the United States and in the
general market for health care items and services on Medicaid and CHIP.
(G) Interactions with Medicare and
Medicaid
Consistent with paragraph (11), the
interaction of policies under Medicaid and the Medicare program under
subchapter XVIII, including with respect to how such interactions affect access
to services, payments, and dual eligible individuals.
(H) Other access policies
The effect of other Medicaid and CHIP
policies on access to covered items and services, including policies relating
to transportation and language barriers and preventive, acute, and long-term
services and supports.
(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.
(4) Creation of early-warning system
MACPAC shall create an early-warning
system to identify provider shortage areas, 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.
(5) Comments on certain secretarial
reports and regulations
(A) Certain secretarial reports
If the Secretary submits to Congress (or
a committee of Congress) a report that is required by law and that relates to
access policies, including with respect to payment policies, under Medicaid or
CHIP, the Secretary shall transmit a copy of the report to MACPAC. MACPAC shall
review the report and, not later than 6 months after the date of submittal of
the Secretary’s report to Congress, shall submit to the appropriate committees
of Congress and the Secretary written comments on such report. Such comments
may include such recommendations as MACPAC deems appropriate.
(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.
(6) Agenda and additional reviews
(A) In general
MACPAC shall consult periodically with
the chairmen and ranking minority members of the appropriate committees of
Congress regarding MACPAC’s agenda and progress towards achieving the agenda.
MACPAC may conduct additional reviews, and submit additional reports to the
appropriate committees of Congress, from time to time on such topics relating
to the program under this subchapter or subchapter XXI as may be requested by
such chairmen and members and as MACPAC deems appropriate.
(B) Review and reports regarding Medicaid
DSH
(i) In general MACPAC shall review and
submit an annual report to Congress on disproportionate share hospital payments
under section 1396r–4 of this title. Each report shall
include the information specified in clause (ii).
(ii) Required report information Each
report required under this subparagraph shall include the following:
(I) Data relating to changes in the
number of uninsured individuals.
(II) Data relating to the amount and
sources of hospitals’ uncompensated care costs, including the amount of such
costs that are the result of providing unreimbursed or under-reimbursed
services, charity care, or bad debt.
(III) Data identifying hospitals with
high levels of uncompensated care that also provide access to essential
community services for low-income, uninsured, and vulnerable populations, such
as graduate medical education, and the continuum of primary through quarternary
care, including the provision of trauma care and public health services.
(IV) State-specific analyses regarding
the relationship between the most recent State DSH allotment and the projected
State DSH allotment for the succeeding year and the data reported under
subclauses (I), (II), and (III) for the State.
(iii) Data Notwithstanding any other
provision of law, the Secretary regularly shall provide MACPAC with the most
recent State reports and most recent independent certified audits submitted
under section 1396r–4 (j) of this title, cost reports submitted
under subchapter XVIII of this chapter, and such other data as MACPAC may
request for purposes of conducting the reviews and preparing and submitting the
annual reports required under this subparagraph.
(iv) Submission deadlines The first
report required under this subparagraph shall be submitted to Congress not
later than February 1, 2016. Subsequent reports shall be submitted as part of,
or with, each annual report required under paragraph (1)(C) during the period
of fiscal years 2017 through 2024.
(7) Availability of reports
MACPAC shall transmit to the Secretary a
copy of each report submitted under this subsection and shall make such reports
available to the public.
(8) Appropriate committee of Congress
For purposes of this section, the term
“appropriate committees of Congress” means the Committee on Energy and Commerce
of the House of Representatives and the Committee on Finance of the Senate.
(9) Voting and reporting requirements
With respect to each recommendation
contained in a report submitted under paragraph (1), each member of MACPAC
shall vote on the recommendation, and MACPAC shall include, by member, the results
of that vote in the report containing the recommendation.
(10) Examination of budget consequences
Before making any recommendations,
MACPAC shall examine the budget consequences of such recommendations, directly
or through consultation with appropriate expert entities, and shall submit with
any recommendations, a report on the Federal and State-specific budget
consequences of the recommendations.
(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 1395b–6 of this title 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 subchapter 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 [1] 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.
(c) Membership
(1) Number and appointment
MACPAC shall be composed of 17 members
appointed by the Comptroller General of the United States.
(2) Qualifications
(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.
(C) Majority nonproviders
Individuals who are directly involved in
the provision, or management of the delivery, of items and services covered
under Medicaid or CHIP shall not constitute a majority of the membership of
MACPAC.
(D) Ethical disclosure
The Comptroller General of the United
States shall establish a system for public disclosure by members of MACPAC of
financial and other potential conflicts of interest relating to such members.
Members of MACPAC shall be treated as employees of Congress for purposes of
applying title I of the Ethics in Government Act of 1978 (Public Law 95–521) [5
U.S.C. App.].
(3) Terms
(A) In general
The terms of members of MACPAC shall be
for 3 years except that the Comptroller General of the United States shall
designate staggered terms for the members first appointed.
(B) Vacancies
Any member appointed to fill a vacancy
occurring before the expiration of the term for which the member’s predecessor
was appointed shall be appointed only for the remainder of that term. A member
may serve after the expiration of that member’s term until a successor has taken
office. A vacancy in MACPAC shall be filled in the manner in which the original
appointment was made.
(4) Compensation
While serving on the business of MACPAC
(including travel time), a member of MACPAC shall be entitled to compensation
at the per diem equivalent of the rate provided for level IV of the Executive
Schedule under section 5315 of title 5;
and while so serving away from home and the member’s regular place of business,
a member may be allowed travel expenses, as authorized by the Chairman of
MACPAC. Physicians serving as personnel of MACPAC may be provided a physician
comparability allowance by MACPAC in the same manner as Government physicians
may be provided such an allowance by an agency under section 5948
of title 5, and for such purpose subsection (i) of such
section shall apply to MACPAC in the same manner as it applies to the Tennessee
Valley Authority. For purposes of pay (other than pay of members of MACPAC) and
employment benefits, rights, and privileges, all personnel of MACPAC shall be
treated as if they were employees of the United States Senate.
(5) Chairman; Vice Chairman
The Comptroller General of the United
States shall designate a member of MACPAC, at the time of appointment of the
member [2] as Chairman and a
member as Vice Chairman for that term of appointment, except that in the case
of vacancy of the Chairmanship or Vice Chairmanship, the Comptroller General of
the United States may designate another member for the remainder of that member’s
term.
(6) Meetings
MACPAC shall meet at the call of the
Chairman.
(d) Director and staff; experts and
consultants
Subject to such review as the
Comptroller General of the United States deems necessary to assure the
efficient administration of MACPAC, MACPAC may—
(1) employ and fix the compensation of
an Executive Director (subject to the approval of the Comptroller General of
the United States) and such other personnel as may be necessary to carry out
its duties (without regard to the provisions of title 5 governing appointments
in the competitive service);
(2) seek such assistance and support as
may be required in the performance of its duties from appropriate Federal and
State departments and agencies;
(3) enter into contracts or make other
arrangements, as may be necessary for the conduct of the work of MACPAC
(without regard to section 6101
of title 41);
(4) make advance, progress, and other
payments which relate to the work of MACPAC;
(5) provide transportation and
subsistence for persons serving without compensation; and
(6) prescribe such rules and regulations
as it deems necessary with respect to the internal organization and operation
of MACPAC.
(e) Powers
(1) Obtaining official data
MACPAC may secure directly from any
department or agency of the United States and, as a condition for receiving
payments under sections 1396b
(a) and 1397ee (a) of this title, from any State agency
responsible for administering Medicaid or CHIP, information necessary to enable
it to carry out this section. Upon request of the Chairman, the head of that
department or agency shall furnish that information to MACPAC on an agreed upon
schedule.
(2) Data collection
In order to carry out its functions,
MACPAC shall—
(A) utilize existing information, both
published and unpublished, where possible, collected and assessed either by its
own staff or under other arrangements made in accordance with this section;
(B) carry out, or award grants or
contracts for, original research and experimentation, where existing
information is inadequate; and
(C) adopt procedures allowing any
interested party to submit information for MACPAC’s use in making reports and
recommendations.
(3) Access of GAO to information
The Comptroller General of the United
States shall have unrestricted access to all deliberations, records, and
nonproprietary data of MACPAC, immediately upon request.
(4) Periodic audit
MACPAC shall be subject to periodic
audit by the Comptroller General of the United States.
(f) Funding
(1) Request for appropriations
MACPAC shall submit requests for
appropriations (other than for fiscal year 2010) in the same manner as the
Comptroller General of the United States submits requests for appropriations,
but amounts appropriated for MACPAC shall be separate from amounts appropriated
for the Comptroller General of the United States.
(2) Authorization
There are authorized to be appropriated
such sums as may be necessary to carry out the provisions of this section.
(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 1397dd (a)(13) of this title, 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.
[1] See References in Text note
below.
