Medicaid and CHIP Payment and Access Commission PUBLIC MEETING Horizon Ballroom Ronald Reagan Building and International Trade Center 1300 Pennsylvania Avenue, NW Washington, D.C. 20004 Thursday, February 20, 2014 8:44 a.m. COMMISSIONERS PRESENT: DIANE ROWLAND, ScD, Chair DAVID SUNDWALL, MD, Vice Chair SHARON L. CARTE, MHS RICHARD CHAMBERS DONNA CHECKETT, MPA, MSW ANDREA COHEN, JD BURTON L. EDELSTEIN, DDS, MPH PATRICIA GABOW, MD DENISE HENNING, CNM, MSN MARK HOYT, FSA, MAAA NORMA MARTÍNEZ ROGERS, PhD, RN, FAAN JUDITH MOORE TRISH RILEY, MS SARA ROSENBAUM, JD ROBIN SMITH ANNE L. SCHWARTZ, PhD, Executive Director MACPAC February 2014 AGENDA PAGE Session 2: Review of March MACStats, New MACPAC Web Products Molly McGinn-Shapiro, Senior Analyst .......................................................................................................... 4 Ben Finder, Senior Analyst ............................................................................................................................... 5 April Grady, Director of Data Development & Analysis ............................................................................ 8 Session 3: Eligibility and Enrollment Strategies Introduction: Moira Forbes, Director of Payment and Program Integrity Introduction: Moira Forbes, Director of Payment and Program Integrity ............................................. 14 Alice Weiss, Program Director, National Academy for State Health Policy........................................... 15 Ruth Kennedy, Medicaid Director, State of Louisiana ............................................................................... 25 Lisa Lee, Deputy Commissioner, Department for Medicaid Services, State of Kentucky ................... 32 Session 4: Use of the Emergency Department by Medicaid Enrollees Introduction: Anna Sommers, Director of Access and Quality ................................................................ 61 Arthur Kellermann, Dean, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences ..................................................................................................................................... 62 Stacey McMorrow, Senior Research Associate, Urban Institute ............................................................... 68 Maria Raven, Assistant Professor, Department of Emergency Medicine, School of Medicine, University of California at San Francisco ..................................................................................................... 73 Session 5: Review of Secretary’s Report on Express Lane Eligibility Moira Forbes, Director of Payment and Program Integrity ................................................................... 104 Session 6: The Future of CHIP Chris Peterson, Director of Eligibility, Enrollment and Benefits .................................................. 123/137 Ben Finder, Senior Analyst .......................................................................................................................... 129 Lindsay Hebert, Special Assistant to Executive Director ....................................................................... 131 Veronica Daher, Senior Analyst .................................................................................................................. 134 MACPAC February 2014 AGENDA PAGE Session 7: Assessment of Need for Medicaid Long-Term Services and Supports Introduction: Angela Lello, Senior Analyst ............................................................................................... 153 Lisa Alecxih, Senior Vice President, The Lewin Group.......................................................................... 153 Charles Moseley, Associate Executive Director, National Association of State Directors of Developmental Disabilities Services........................................................................................................... 156 Jennifer Mathis, Deputy Legal Director and Director of Programs, Bazelon Center for Mental Health Law ..................................................................................................................................................... 162 Session 8: Medicaid and Population Health: Policy Issues Amy Bernstein, Senior Advisor .................................................................................................................. 197 Public Comment ...................................................................................................................................................... 215 Adjourn ....................................................................................................................................................................... 216 MACPAC February 2014 Page 4 of 216 1 P R O C E E D I N G S [8:44 a.m.] 2 CHAIR ROWLAND: Good morning. If we could please come to order, and we are pleased to 3 start today with an update on our MACStats and on our continued efforts to provide ongoing data 4 information about both the Medicaid and CHIP programs. So I am going to turn to Ben Finder to kick it 5 off -- oh, to Molly McGinn-Shapiro. 6 MS. McGINN-SHAPIRO: Yes. 7 CHAIR ROWLAND: So it is the order that you are in. Okay. 8 #### Session 2: Review of March MACStats, New MACPAC Web Products 9 * MS. McGINN-SHAPIRO: Thank you. So just briefly, Ben and I would like to show you a couple 10 of recent publications that we have posted online. You can find these new publications off of our main 11 website, which is www.macpac.gov, and you just need to click on the "Other Publications" tab. So I'm 12 going to show you where that is, and then hopefully it will bring that up. There we go. 13 And so you can find these new publications -- you know, the documents that we discussed -- both 14 under these recently posted documents, and then also the documents that we're discussing will also -- are 15 under "State Policies." 16 So I am going to start with the financial alignment initiative document, which is a series of tables 17 that we've developed to make it easier for you to compare the design of the CMS financial alignment 18 demonstration projects for individuals dually eligible for Medicaid and Medicare in those participating states. 19 So let me pull that up for you. 20 And so this document, there are eight tables that provide an overview of the progress of the 21 financial alignment initiative as it moves along. And so then this just provides an overview of what's in MACPAC February 2014 Page 5 of 216 1 those tables, and then as you scroll down, you'll see there will be several tables. And they review the key 2 elements of the state financial alignment demonstration projects for states that have signed the 3 memorandum of understanding with CMS, including the target population, the enrollment process, benefit 4 design, payment policies, and other such details. 5 Information on these state demonstrations are primarily pulled from the publicly available 6 information in a state's signed MOUs, and at the moment eight states have signed MOUs with CMS to 7 implement the financial alignment demonstration project. These tables currently focus on the state projects 8 that are testing the capitated model because they represent the trend towards increasing managed care for 9 dually eligible enrollees that many states are now considering. So we plan to update these tables at a regular 10 basis as new information becomes available, and so just that's where it is. 11 So I'll turn it over to Ben now. 12 * MR. FINDER: Thanks, Molly. 13 So I'm here to tell you about our Medicaid fee-for-service physician payment landscape. Again, it's 14 on our website under "Other Publications." We have this premium spot here at the top, but you can find us 15 forever at the bottom under "State Policies." 16 When you click on the file, there are two sorts of companion pieces that go with this. There is a pdf 17 and an Excel file. And the Medicaid fee-for-service physician landscape is a document in which we have 18 documented the methodology that states use to pay physicians and other professionals. 19 So when you click on the pdf, this is sort of the instruction manual for the Excel spreadsheet. You'll 20 see at the top there's a little blurb that tells you why we did this. Then we get to the methodology of how 21 we did it. And further down this page there's some information on how you can use the summary tables MACPAC February 2014 Page 6 of 216 1 and the state-specific tabs when you get into the actual Excel file. 2 So I'll now turn to the Excel file. It opens up on the summary tab. In the summary tab, you can see 3 the fee schedule basis. So this is the information, and this is in Column B right here. This is how states set 4 their fee-for-service physician payment policies. Some states use an RBRVS system, other states base theirs 5 on the Medicare fee schedule, and some have their own independent methodologies to set their physician 6 payments. 7 We also document whether or not they maintain separate fee schedules for different types of 8 professionals and practitioners; any adjustments they might make, like a geographic adjustment or a site-of- 9 service adjustment; and then further on the right there, there's information about incentive payments that 10 states might make also for their physician payments. 11 So the summary table, like I said, documents a lot of that information for all the states and sort of 12 categorizes it in easy-to-find fashion. If you're interested in more information on a particular state, you can