MACPAC Talks Community Engagement, Prior Authorization Automation

The Medicaid and CHIP Payment and Access Commission (MACPAC) met Jan. 29-30 for the third meeting of the term. Commissioners heard public presentations and led public discussion about key Medicaid issues, including:

• Community engagement requirements implementation policy options
• Automation in the prior authorization process
• Coverage for various youth populations
• Accountability of Medicaid managed care organizations

The commission discussed a recommendation for the Centers for Medicare & Medicaid Services to develop a plan for monitoring and evaluating community engagement requirements. The plan would illustrate this policy's effect on Medicaid eligibility and enrollment, employment, and other identified goals. Commissioners supported this recommendation and suggested additional metrics. The recommendation will appear in the June report to Congress.

The commission also discussed findings from stakeholder interviews on artificial intelligence (AI) in the prior authorization process. Commissioners were interested in further research and likely will make recommendations on guiding principles and guardrails for AI in prior authorizations.

At the meeting, America's Essential Hospitals staff highlighted the Reinforcing Essential Health Systems for Communities Act (H.R. 7145) and how essential health system designation could mitigate the cuts from the Working Families Tax Cut legislation.

Members of the America's Essential Hospitals Federal Action Network (FAN) can access a full summary of the discussion. To access this summary and other policy resources, join the FAN today.

MACPAC meets six times a year and submits reports to Congress in March and June. MACPAC's next public meeting is March 5.

Contact Director of Policy Rob Nelb, MPH, at [email protected] or 202.585.0127 with questions.