This Thursday, MedPAC kicks off the 2025-2026 meeting cycle when we convene our September public meeting. For our September meeting, we are delighted to welcome the Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), Gene Dodaro, who will present GAO’s work on reducing improper payments and improving the sustainability of the Medicare program. This is a unique opportunity to highlight this important work and for Commissioners to discuss opportunities to improve the value of Medicare spending for taxpayers and beneficiaries.
MedPAC strives for transparency by webcasting the Commission’s public meetings; publishing the transcript and presentations following such meetings; and publishing online all its reports, comment letters, and congressional testimony, as well as letters submitted to us by interested parties in response to public meeting discussions. In this spirit of transparency, we are excited to share some of the policy issues the Commission plans to work on throughout the rest of our meeting cycle. The agenda is subject to change based on data availability, analytic progress, the Commission’s discussions, and changing circumstances.
The Commission is required by statute to deliver two reports to the Congress each year: one by March 15th and another by June 15th. Our March report analyzes the adequacy of Medicare’s payments and makes recommendations to the Congress on whether and how those payments should be updated. Our June report focuses on broader questions affecting the Medicare program, and it too can include recommendations to the Congress for improving Medicare’s payment systems to promote beneficiary access to care and efficient use of program resources. MedPAC publishes periodic data books with information about the Medicare program, its beneficiaries, and participating providers and plans; it also writes comment letters responding to proposed rules from the Centers for Medicare & Medicaid Services. Additionally, MedPAC produces its yearly Payment Basics series that explains how different Medicare payment systems work.
In the coming months, the Commission will analyze the adequacy of Medicare’s fee-for-service (FFS) payments for hospitals, clinicians, outpatient dialysis facilities, skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and hospice agencies. The Commission also will deliver updated status reports on the Medicare Advantage (MA) and Part D programs, and on ambulatory surgical centers. These analyses will include information on Medicare payments, beneficiary access to care, and—where possible—the quality of care provided to beneficiaries.
The Commission will also continue its work assessing the MA program. The MA program has grown significantly over the past decade, and it is increasingly important to understand enrollees’ experience in the program and its effect on the federal budget. We will continue examining MA plan provider networks and access to care, institutionalized beneficiaries enrolled in MA, and risk adjustment, including the role of encounter data. We also plan to examine how MA plans pay providers for care and the financial impact MA has on providers.
We will conduct our annual review of the Medicare prescription drug program (Part D), including program spending, enrollment and benefit offerings, and beneficiary cost sharing. We plan to continue to monitor the availability of benchmark plans for LIS beneficiaries. We also plan to analyze drug pricing data submitted by Part D plans and analyze plan bids to understand how the IRA and other policy changes are affecting the stability of the PDP market.
We are working on several other issues in the Medicare program as well, such as work to describe the complexity of choices for Medicare beneficiaries and information and assistance available to beneficiaries when making choices. We also plan to explore an additional method of measuring changes in the volume of physician fee schedule services.
The Commission will complete work on three additional reports mandated by the Bipartisan Budget Act of 2018. We will analyze recent changes to the home health prospective payment system, including the impact of the new 30-day unit of payment, for a report that is due in March 2026. We will update analysis on the performance of MA dual-eligible special needs plans for a report that is also due in March 2026. Finally, we will continue analysis of newly reported data for ambulance services and make a recommendation on whether such data collection should continue for a report that is due in June 2026. The Commission will also continue to work on two reports required annually, including a report on Medicaid use and spending and non–FFS Medicare margins in nursing homes, required by the Affordable Care Act of 2010, and a report on payments to rural emergency hospitals, required by the Consolidated Appropriations Act, 2021.
MedPAC’s agenda is shaped by a combination of statutory requirements, congressional interest, and the interests of the Commission, at the direction of MedPAC’s Chair and Executive Director. Three core principles guide our work: (1) payments should be sufficient to support beneficiary access to high-quality health care in an appropriate clinical setting; (2) Medicare payments should reflect efficient care delivery, thereby ensuring that the program’s fiscal burden on beneficiaries and taxpayers is not greater than necessary; and (3) providers should have incentives to supply appropriate and equitable care in an efficient manner. In all our work, MedPAC follows a deliberative, analytic process to provide the Congress with thoughtful, empirically based information and advice on Medicare.
We look forward to an exciting year ahead and hope that you will tune in to our public meetings. Please reach out if you have any questions about MedPAC’s work.
