42 USC 1396 - Medicaid and CHIP Payment and Access Commission

U.S Code last checked for updates: Oct 16, 2024

§ 1396.

Medicaid and CHIP Payment and Access Commission

(a)

Establishment

(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

(C)

Enrollment and retention processes

(D)

Coverage policies

(E)

Quality of care

(F)

Interaction of Medicaid and CHIP payment policies with health care delivery generally

(G)

Interactions with Medicare and Medicaid

(H)

Other access policies

(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

(5)

Comments on certain secretarial reports and regulations

(A)

Certain secretarial reports

(B)

Regulations

(6)

Agenda and additional reviews

(A)

In general

(B)

Review and reports regarding Medicaid DSH

(i)

In general

(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

(iv)

Submission deadlines

(7)

Availability of reports

(8)

Appropriate committee of Congress

(9)

Voting and reporting requirements

(10)

Examination of budget consequences

(11)

Consultation and coordination with MEDPAC

(A)

In general

(B)

Information sharing

(12)

Consultation with States

(13)

Coordinate and consult with the Federal Coordinated Health Care Office

(14)

Programmatic oversight vested in the Secretary

(c)

Membership

(1)

Number and appointment

(2)

Qualifications

(A)

In general

(B)

Inclusion

(C)

Majority nonproviders

(D)

Ethical disclosure

(3)

Terms

(A)

In general

(B)

Vacancies

(4)

Compensation

(5)

Chairman; Vice Chairman

(6)

Meetings

(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

(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

(4)

Periodic audit

(f)

Funding

(1)

Request for appropriations

(2)

Authorization

(3)

Funding for fiscal year 2010

(A)

In general

(B)

Transfer of funds

(4)

Availability

(Aug. 14, 1935, ch. 531, title XIX, § 1900, as added Pub. L. 111–3, title V, § 506(a), Feb. 4, 2009, 123 Stat. 91; amended Pub. L. 111–148, title II, § 2801(a), Mar. 23, 2010, 124 Stat. 328; Pub. L. 113–93, title II, § 221(b), Apr. 1, 2014, 128 Stat. 1076; Pub. L. 117–286, § 4(c)(43), Dec. 27, 2022, 136 Stat. 4359.)

cite as: 42 USC 1396