By Tara Mancini

In case you missed it amongst all the noise generated by security leaks, the Supreme Court’s ban on patenting human genes, and Chris Christie slow-jamming the news on Late Night with Jimmy Fallon, last week MACPAC released the June edition of its biannual report.

Chapters 1-3 cover maternity services, the Medicaid primary care physician payment increase, and access to care for persons with disabilities.  Chapters 4-5 provide updates on issues raised in previous MACPAC reports, including efforts by CMS to improve the timeliness, quality, and availability of Medicaid and CHIP data, and Medicaid program integrity activities.  Below are a few of the highlights from the chapters on maternity care and the primary care physician payment increase.

In regard to pregnancy services it’s notable that that in 2010, Medicaid and CHIP paid for 1.8 million hospital births, accounting for almost half of the country’s births. As such, Medicaid and CHIP have the ability to greatly improve the effectiveness of maternity care, and the chapter reviews some of the state and federal initiatives to do so. In addition, the report brings to light the fact that while pregnant women stand to benefit from provisions of the ACA, especially the streamlining of Medicaid eligibility and premium tax credits to subsidize exchange coverage, discontinuity of care remains a concern. This is due to the continuance of separate eligibility pathways based on pregnancy status.

Similarly, we know the primary care physician payment increase is an important provision of the ACA that has been discussed in depth by my colleagues Tricia Brooks and Wesley Prater. However, interviews conducted by the Commission with physicians in Alabama, California, Indiana, Massachusetts, Oregon, Rhode Island, and D.C., as well as conversations with Medicaid officials and other stakeholders reveal some of the complexities associated with implementation.

Concerns surround the difficulty in first identifying and then programming the Medicaid Management Information System (MMIS) – the claims processing and information retrieval system – to flag eligible providers and services. Aligning alternative payment methods, particularly in states that are trying to move away from FFS presents another issue.  Considered together with the short time frame available for implementation, this  means that states will have to make at least some of the increased payments retroactively.  Additionally, the question remains whether the payment increase will improve access generally, given the temporary nature of the pay increase, and specifically in areas that rely on non-physician providers.

So keep your eyes out for future findings, as the Commission will continue to monitor implementation and evaluation of the primary care rate increase as well as how changes in eligibility under the ACA affect pregnant women. Perhaps we will even be so lucky to hear one of the MACPAC commissioners slow-jam the news.