Medicaid and CHIP Payment and Access Commission
Establishment
Duties
Review of access policies for all States and annual reports
MACPAC shall—
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);
make recommendations to Congress, the Secretary, and States concerning such access policies;
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
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.
Specific topics to be reviewed
Specifically, MACPAC shall review and assess the following:
Medicaid and CHIP payment policies
Payment policies under Medicaid and CHIP, including—
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;
payment methodologies; and
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).
Eligibility policies
Enrollment and retention processes
Coverage policies
Quality of care
Interaction of Medicaid and CHIP payment policies with health care delivery generally
Interactions with Medicare and Medicaid
Other access policies
Recommendations and reports of State-specific data
MACPAC shall—
review national and State-specific Medicaid and CHIP data; and
submit reports and recommendations to Congress, the Secretary, and States based on such reviews.
Creation of early-warning system
Comments on certain secretarial reports and regulations
Certain secretarial reports
Regulations
Agenda and additional reviews
In general
Review and reports regarding Medicaid DSH
In general
Required report information
Each report required under this subparagraph shall include the following:
Data relating to changes in the number of uninsured individuals.
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.
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.
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.
Data
Submission deadlines
Availability of reports
Appropriate committee of Congress
Voting and reporting requirements
Examination of budget consequences
Consultation and coordination with MEDPAC
In general
Information sharing
Consultation with States
Coordinate and consult with the Federal Coordinated Health Care Office
Programmatic oversight vested in the Secretary
Membership
Number and appointment
Qualifications
In general
Inclusion
Majority nonproviders
Ethical disclosure
Terms
In general
Vacancies
Compensation
Chairman; Vice Chairman
Meetings
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—
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);
seek such assistance and support as may be required in the performance of its duties from appropriate Federal and State departments and agencies;
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);
make advance, progress, and other payments which relate to the work of MACPAC;
provide transportation and subsistence for persons serving without compensation; and
prescribe such rules and regulations as it deems necessary with respect to the internal organization and operation of MACPAC.
Powers
Obtaining official data
Data collection
In order to carry out its functions, MACPAC shall—
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;
carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate; and
adopt procedures allowing any interested party to submit information for MACPAC’s use in making reports and recommendations.
Access of GAO to information
Periodic audit
Funding
Request for appropriations
Authorization
Funding for fiscal year 2010
In general
Transfer of funds
Availability
Source
(Aug. 14, 1935, ch. 531, title XIX, § 1900, as added Pub. L. 111–3, title V, § 506(a),Notes
References in Text
Codification
Prior Provisions
Amendments
Effective Date
General Effective Date.—
Unless otherwise provided in this Act [enacting this section and sections 247d–9, 1320b–9a, 1396e–1, 1396w–2, and 1397kk to 1397mm of this title and section 657p of Title 15, Commerce and Trade, transferring former section 1396 of this title to section 1396–1 of this title, amending sections 300gg, 1308, 1320b–9, 1320b–9a, 1396a, 1396b, 1396r–1, 1396r–4, 1396u–7, 1397bb to 1397ee, and 1397gg to 1397jj of this title, section 1514 of Title 19, Customs Duties, sections 5701 to 5703, 5712, 5713, 5721 to 5723, 5741, 6103, and 9801 of Title 26, Internal Revenue Code, and sections 1022, 1132, and 1181 of Title 29, Labor, enacting provisions set out as notes under this section and sections 1305, 1396a, 1396b, 1396d, 1396u–7, 1396u–8, 1396w–2, 1397bb to 1397ee, 1397gg, and 1397hh of this title, section 1514 of Title 19, sections 5701 to 5703, 5711, 5712, 6103, and 6655 of Title 26, and section 1181 of Title 29, amending provisions set out as a note under section 1397gg of this title, and repealing provisions set out as notes under sections 1397aa and 1397ee of this title], subject to subsections (b) through (d), this Act (and the amendments made by this Act) shall take effect on
Exception for State Legislation.—
In the case of a State plan under title XIX [42 U.S.C. 1396 et seq.] or State child health plan under [title] XXI [42 U.S.C. 1397aa et seq.] of the Social Security Act, which the Secretary of Health and Human Services determines requires State legislation in order for the respective plan to meet one or more additional requirements imposed by amendments made by this Act, the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act [
Coordination of CHIP Funding for Fiscal Year 2009.—
Notwithstanding any other provision of law, insofar as funds have been appropriated under section 2104(a)(11), 2104(k), or 2104(l) of the Social Security Act [42 U.S.C. 1397dd(a)(11), (k), (l)], as amended by section 201 of Public Law 110–173, to provide allotments to States under CHIP for fiscal year 2009—
any amounts that are so appropriated that are not so allotted and obligated before
any amount provided for CHIP allotments to a State under this Act (and the amendments made by this Act) for such fiscal year shall be reduced by the amount of such appropriations so allotted and obligated before such date.
Reliance on Law.—
With respect to amendments made by this Act (other than title VII) [enacting this section and sections 1320b–9a, 1396e–1, 1396w–2, and 1397kk to 1397mm of this title, amending sections 300gg, 1308, 1320b–9, 1320b–9a, 1396a, 1396b, 1396r–1, 1396r–4, 1396u–7, 1397bb to 1397ee, and 1397gg to 1397jj of this title, section 9801 of Title 26, Internal Revenue Code, and sections 1022, 1132, and 1181 of Title 29, Labor, amending provisions set out as a note under section 1397gg of this title, and repealing provisions set out as notes under sections 1397aa and 1397ee of this title] that become effective as of a date—
such amendments are effective as of such date whether or not regulations implementing such amendments have been issued; and
Federal financial participation for medical assistance or child health assistance furnished under title XIX or XXI, respectively, of the Social Security Act [42 U.S.C. 1396 et seq., 1397aa et seq.] on or after such date by a State in good faith reliance on such amendments before the date of promulgation of final regulations, if any, to carry out such amendments (or before the date of guidance, if any, regarding the implementation of such amendments) shall not be denied on the basis of the State’s failure to comply with such regulations or guidance.”
Purpose
Model of Interstate Coordinated Enrollment and Coverage Process
In General.—
In order to assure continuity of coverage of low-income children under the Medicaid program and the State Children’s Health Insurance Program (CHIP), not later than 18 months after the date of the enactment of this Act [
Report to Congress.—
After development of such model process, the Secretary of Health and Human Services shall submit to Congress a report describing additional steps or authority needed to make further improvements to coordinate the enrollment, retention, and coverage under CHIP and Medicaid of children described in subsection (a).”
Improved Accessibility of Dental Provider Information to Enrollees Under Medicaid and CHIP
work with States, pediatric dentists, and other dental providers (including providers that are, or are affiliated with, a school of dentistry) to include, not later than 6 months after the date of the enactment of this Act [
work with States to include, not later than 6 months after the date of the enactment of this Act, a description of the dental services provided under each State plan (or waiver) under Medicaid and each State child health plan (or waiver) under CHIP on such Insure Kids Now website, and shall ensure that such list is updated at least annually.”
Deadline for Initial Appointments
Annual Report
No Federal Funding for Illegal Aliens; Disallowance for Unauthorized Expenditures
Definitions
CHIP.—
The term ‘CHIP’ means the State Children’s Health Insurance Program established under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.).
Medicaid.—
The term ‘Medicaid’ means the program for medical assistance established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).
Secretary.—
The term ‘Secretary’ means the Secretary of Health and Human Services.”