MACPAC Votes on Recommendations and Discusses MOUD and Managed Care Oversight

The Medicaid and CHIP Payment and Access Commission (MACPAC) met on Jan. 23 and 24 to discuss a variety of topics including the utilization of Medications for Opioid Use Disorder (MOUD) in Medicaid and the role of external quality review in managed care oversight and accountability. The commission also voted on recommendations to be included in their March 2025 report to Congress.  

In reviewing MOUD utilization in Medicaid, commissioners discussed trends in application, including variations in utilization rate based on the types of MOUD used, variation in beneficiary demographics, and changes in trends following coverage of MOUD in a state's Medicaid program. As next steps, the commission will include these findings in their June 2025 report to Congress, present additional findings from stakeholder interviews, and consider examining the use of prior authorization for MOUD in Medicaid.  

Further, commissioners reviewed and approved three recommendations related to the role of external quality review in managed care oversight and accountability, which will appear in their March 2025 report to Congress. The first would direct the Centers for Medicare & Medicaid Services (CMS) to require external quality review (EQR) annual technical reports to include outcomes data and results from quantitative assessments. The second recommendation would direct the CMS to update EQR protocols to reduce areas of duplication with other federal quality and oversight reporting requirements, standardize structure in the annual technical report, and identify key takeaways on plan performance. Lastly, the third recommendation would direct the CMS to require states publish EQR annual technical reports in a central repository on the CMS website. 

MACPAC also voted on and approved two recommendations related to home and community-based services (HCBS). The first recommendation directs the CMS to issue guidance on how states can use provision plans of care related to HCBS. The second recommendation suggests Congress amend the Medicaid statute to increase the renewal period for HCBS programs operating under a section 1915(c) waiver or a state plan amendment from five years to 10 years.