Summary of the Medical Care Advisory Committee and Beneficiary Advisory Group Provisions
Ensuring beneficiaries can access covered services is a critical function of the Medicaid program and a top priority of the Centers for Medicare & Medicaid Services (CMS). The proposed rule, Ensuring Access to Medicaid Services, outlined in this fact sheet includes both proposed changes to current requirements and newly proposed requirements that would advance the CMS’s efforts to improve access to care, quality, and health outcomes, and better promote health equity for Medicaid beneficiaries across fee-for-service (FFS) and managed care delivery systems, including for home and community-based services (HCBS) provided through those delivery systems. These proposed requirements are intended to increase transparency and accountability, standardize data and monitoring, and create opportunities for states to promote active beneficiary engagement in their Medicaid programs. Medicaid and CHIP are the nation’s largest health coverage programs. If adopted as proposed, these rules would build on Medicaid’s already strong foundation as an essential program for millions of families and individuals, especially children, pregnant people, older adults, and people with disabilities.
Public comments are requested on the Notice of Proposed Rulemaking (NPRM), including in response to specific questions articulated throughout the publication.
Section 1902(a)(4) of the Act is a longstanding statutory provision that, as implemented in part in regulations currently codified at § 431.12, requires states to have a Medical Care Advisory Committee (MCAC) in place to advise the state Medicaid agency about health and medical care services. Recent research regarding soliciting input from individuals with lived experience, including discussions with states about their MCAC, provides CMS with a unique opportunity to re-examine the purpose of this committee and update the policies to reflect four decades of program experience. Based on these learnings, we know that these requirements need to be more robust to ensure all states are using these committees optimally to leverage the experiences of beneficiaries, their caretakers, and other stakeholders. The MCAC provisions of the proposed rule outline changes that will support the implementation of the principles of two-way feedback, transparency, and accountability.
The proposed rule would change the MCAC structure and operations to support more meaningful and accessible engagement by all Committee members with a particular emphasis on Medicaid beneficiaries. If finalized, these provisions will:
- Rename and expand the scope and use of states’ Medical Care Advisory Committees. States would be required to establish and operate the newly named Medicaid Advisory Committee (MAC) and a Beneficiary Advisory Group (BAG). The MAC and its corresponding BAG would serve as vehicles for two-way communication between interested parties and the state on topics related to the effective administration of the Medicaid program. The proposals in the proposed rule seek to expand the topics to be addressed by the Committee beyond health and medical services to include policy development and effective program administration. The specific topics addressed by the MAC would be based on each state’s needs and determined in collaboration with the MAC members.
- Establish minimum requirements for stakeholder representation on the MAC. The MAC would include representation from the BAG, and other interested parties, such as consumer advocacy groups, clinical providers or administrators, Medicaid managed care plans, and other state agencies serving Medicaid beneficiaries. States would select members in a way that reflects a wide range of their Medicaid stakeholders (i.e., covering a diverse set of populations and interests relevant to the Medicaid program), places a special emphasis on the inclusion of the Medicaid beneficiary perspective, and creates a meeting environment where each voice is empowered to participate equally.
- Require states to establish a beneficiary-only group with crossover membership with the MAC. Under the proposal, States would be required to establish the BAG, a standalone group, that will meet separately from the MAC. The BAG would include Medicaid beneficiaries, their family members, and/or their caregivers. At least 25 percent of the MAC membership would be reserved for BAG members.
- Promote transparency and accountability between the state and its stakeholders by making information on the MAC and BAG activities publicly available. In order to be responsive to the needs of its stakeholders, states need to be able to gather feedback from a variety of people that touch the Medicaid program. Under our proposal, the MAC and BAG will serve as the vehicle through which states can obtain this feedback. In turn, states will publicly share information about the feedback they receive. Specifically, states will post MAC and BAG membership lists, meeting schedules, meeting minutes, by-laws, recruitment processes, and an annual report on MAC activities on its website. The annual report will seek to both promote transparency and accountability at the state level by providing a public view into the impact of the MAC and BAG’s feedback.
Federal financial participation for MAC and BAG activities would remain available to states in the same manner as for the current MCAC.
There will be a 60-day comment period for the notice of proposed rulemaking, and comments must be submitted to the Federal Register no later than [date 60 days after date of NPRM publication in the Federal Register]. For more information on how to submit comments or to review the entire rule, visit the Federal Register.
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