Advisory Committee Requirements in the Access Rule: What’s Next for Implementation?

On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) released three final rules, including the Ensuring Access to Medicaid Services final rule(Access Rule). One provision of the Access Rule calls for states to replace the 40-year-old Medical Care Advisory Committee (MCAC) with the Medicaid Advisory Committee (MAC) and Beneficiary Advisory Council (BAC); CMS has posted an Access Rule fact sheet and effective dates chart to aid implementation.This third entry in our Aurrera Health blog series on the Access and Managed Care final rules focuses on provisions specific to the MAC and BAC to help states and partners digest the new requirements and consider their next steps.  Each state has an MCAC, comprised of providers, consumers, and government representatives. The MCAC was established primarily to advise state Medicaid agencies on health and medical care services.   Historically, the regulations governing the MCAC lacked the specificity around engaging Medicaid members; for example, the Medicaid and CHIP Payment Access Commission chapter Engaging Beneficiaries through Medical Care Advisory Committee to Inform Medicaid Policymakinghighlighted recruitment, engagement strategies, and financial support as three challenges to meaningfully including Medicaid members in the MCAC. The Access Rule has provisions to address these and other challenges.The MCAC will be restructured as the MAC and BAC primarily to promote engagement of individuals with lived experience and ensure that Committees can efficiently and effectively inform Medicaid policymaking through meaningful membership engagement. Regulatory changes require diverse representation, transparent governance, and active involvement from current and former Medicaid members, their families, and caregivers. By prioritizing voices of Medicaid members in addition to providers and other partners, the MAC and BAC offer a proactive approach to incorporating diverse perspectives and experiences in enhancing Medicaid effectiveness and responsiveness. 

What Are the New MAC and BAC Access Rule Requirements?

AdministrationThe Access Rule requires that MACs and BACs serve as advisory entities that inform state Medicaid directors on policies and programs. The Access Rule helps promote transparency, efficacy, and accessibility by making state Medicaid directors responsible for establishing and standardizing processes and practices for MAC and BAC administration, specifically:

• developing and publicizing the criteria for member recruitment, selection, and service criteria on the state Medicaid website.

• publishing member lists and governance documents including bylaws and meeting minutes with attendee lists.

• producing an annual report that captures MAC and BAC activities, findings, and recommendations.

• providing staff with resources to facilitate effective MAC and BAC participation and engagement.

• ensuring that at least two MAC meetings are open to the public each year, with dedicated time for public comment. 

• offering varied options and formats for meeting attendance, including in-person, virtual, and hybrid formats, and accommodations for individuals with disabilities.

MAC and BAC composition To ensure a diverse MAC composition, the Access Rule calls for Committee members to represent specific areas and professions: 

• state or local consumer advocacy groups, or other community-based organizations that represent the interests of, or provide direct service to, Medicaid members.

• clinical providers or administrators familiar with the needs of Medicaid members.

• participating Medicaid managed care organizations, prepaid inpatient health plans, prepaid ambulatory health plans, and primary care case management entities.

• state agencies that serve Medicaid members (e.g., foster care, aging, health and human services), to serve as ex-officio, non-voting members.

• BAC members, who are individuals currently or previously enrolled in Medicaid, as well as family members or caregivers of Medicaid members; BAC members must comprise at least 25% of the MAC by the end of a three-year phase-in period, and to ensure alignment and thorough preparation for collaboration, the BAC will meet apart from and ahead of the MAC.

The Rule also encourages states to consider the demographics of their state Medicaid population as part of the member selection process.AgendaThe MAC and BAC will determine their areas of focus. Per the Access Rule, topics are likely to include service additions and changes; care coordination; service quality; eligibility processes; member and provider communications; cultural competency; health equity; and access to services.

What Are Implementation Considerations for States?

Though all states currently operate an MCAC, implementing the MAC and BAC in alignment with Access Rule requirements may require additional training, recruitment, and coordination. States may consider the following:

• Recruitment — Effective outreach strategies will be essential to identify candidates and ensure broad, diverse representation, expertise, and perspectives.States can explore utilizing existing beneficiary groups if they meet the membership requirements.

• Coordination — Establishing clear communication channels and governance, including protocols for recommendations and collaboration, will help ensure that the MAC and BAC function smoothly and efficiently.

• Resource Allocation — To support equitable participation, states may consider member compensation, travel expenses, and other costs related to service; this consideration is especially pertinent for BAC members. Adequate and holistic budget planning will be essential to sustain operations over time.

• BAC Training and Support — Knowledge-sharing and information accessibility are essential for member preparation, participation, and engagement. To empower and equip members, states can develop trainings that address relevant and requisite agenda topics as well as tactical and procedural topics such as meeting protocols and communication skills.

• Compliance Monitoring — States will need to develop mechanisms that ensure adherence to the new regulatory standards by monitoring compliance and addressing any non-compliance issues that may arise. This may require establishing reporting requirements, conducting audits or evaluations, and implementing corrective action plans as needed.

These areas call for careful planning, and demand deliberate and thoughtful action to overcome challenges and ensure buy in. Proactive planning and investment in resources and support mechanisms will help states maximize the effectiveness and impact of the MAC and BAC.

Aurrera Health Blog Series on Access and Managed Care Final Rules

Establishing MACs and BACs can yield significant improvements in policymaking effectiveness, member engagement, health equity, and quality of care. Aurrera Health will continue this blog series to synthesize major provisions of the Access and Managed Care final rules, look at state experiences to identify lessons, and provide insights that can inform implementation plans.  We stand ready to help states navigate the new MAC and BAC requirements and elevate the voices of Medicaid members in policymaking. Our expertise includes disparities/equity analysis, meeting facilitation, policy development, stakeholder engagement, outreach, evaluation, and report development, services that may be particularly helpful with respect to MAC and BAC implementation. If you would like to discuss how we can help your state, please reach out to Aurrera Health Managing Principals Megan Thomas or Kristal Vardaman.Please visit the Aurrera Health Group blog webpage to read our other blogs in the series.

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Author

Reatha Conn [Policy Consultant]