Making the data public in a format that enables analysis would improve transparency and understanding of Medicaid payments, according to MACPAC. States make non-DSH supplemental payments, or upper payment limit payments, to hospitals and other providers in addition to DSH payments, which are required by law to help offset the uncompensated care costs of hospitals that serve large shares of Medicaid and uninsured, low-income patients. Non-DSH payments aren’t required by law and don’t have a specified statutory or regulatory purpose, according to the Government Accountability Office.
According to MACPAC, non-DSH supplemental reimbursement accounts for more than 20 percent of total Medicaid fee-for-service payments to hospitals nationwide. “These payments are not reported to the federal government at the provider level in a readily usable format, and, therefore, it is often not possible to determine total payment to individual providers or the effect of these payments on policy objectives such as efficiency, quality and access to necessary services,” the report states.
An analysis of five state Medicaid programs, based on data provided by the states, helped MACPAC conclude it isn’t possible to meaningfully analyze Medicaid payments at the state or provider level without data on non-DSH supplemental payments. Provider-level data on these payments would facilitate payment analysis, including assessments of Medicaid payment adequacy and the relationship between reimbursement and desired outcomes, according to the report.
For more information on Medicaid and CHIP, read the full MACPAC report here.
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