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June 28, 2022

MACPAC, GAO Recommend Oversight Changes for Managed Care Directed Payments

Both The Medicaid and CHIP Access and Payment Commission and the Government Accountability Office have recently published recommendations for increasing transparency of managed care directed payment programs to facilitate closer evaluation of direct payment programs.

MACPAC has released its June 2022 Report to Congress on Medicaid and CHIP, which this year includes a chapter on oversight of managed care directed payments. The Commission’s recommendations are that HHS should: publicly release directed payment approval documents, rate certifications, and evaluations; make provider-level data available for analysis; require states to demonstrate how current payments compare to prior payments and whether the payments are necessary to meet existing network adequacy and access standards; require rigorous, multi-year evaluations; and clarify the roles of CMS divisions and personnel in review of directed payments.

The GAO’s report on directed payment oversight recommends that CMS collect and document complete and consistent provider-specific information about Medicaid payments to providers, including state directed payments, as well as states’ sources of funding for the nonfederal share of these payments.