Executive Summary
By law, the Medicare Payment Advisory Commission reports to the Congress each March on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D). In this year’s report, we:
• consider the context of the Medicare program, including the near-term consequences of the coronavirus pandemic and the longer-term effects of program spending on the federal budget and the program’s financial sustainability.
• evaluate payment adequacy and make recommendations concerning Medicare FFS payment policy in 2023 for acute care hospital, physician and other health professional, ambulatory surgical center, outpatient dialysis facility, skilled nursing facility, home health agency, inpatient rehabilitation facility, long-term care hospital, and hospice services.
• as mandated by the Congress, report on Bipartisan Budget Act (BBA) of 2018 changes to the low-volume hospital payment adjustment.
• as mandated by the Congress, report on the impact of changes to the home health payment system required by the BBA of 2018.
• review the status of the MA program (Medicare Part C), through which beneficiaries can join private plans in lieu of traditional FFS Medicare.
• as mandated by the Congress, report on the performance of specialized MA plans that serve beneficiaries who are dually eligible for Medicare and Medicaid.
• review the status of the Medicare program that provides prescription drug coverage (Medicare Part D).
• as mandated by the Congress in the Consolidated Appropriations Act, 2021, report on a prototype value-based payment program under a unified prospective payment system (PPS) for post-acute care (PAC) services and analyze the impacts of the prototype’s design.