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Advising the Congress on Medicare issues
MedPAC > Recommendations

Commission Recommendations

MedPAC makes recommendations to the Congress and to the Secretary of Health and Human Services on issues affecting the administration of the Medicare program. With its recommendations, the Commission strives to improve the delivery of care, while ensuring financial stability and maximizing value for the program. After extensive analysis and evaluation, our recommendations are discussed and voted on by Commissioners in our public meetings. Recommendations are typically published in two main reports, released in March and June of each year.

Recommendations Topic(s) Date

Improving Medicare’s policies for separately payable drugs in the hospital outpatient prospective payment system (1)

The Congress should direct the Secretary to modify the pass-through drug policy in the hospital outpatient prospective payment system so that it: includes only drugs and biologics that function as supplies to a service and applies only to drugs and biologics that are clinically superior to their packaged analogs.

  • Drugs, Devices, and Tests
  • Hospital

June 2021

Improving Medicare’s policies for separately payable drugs in the hospital outpatient prospective payment system (2)

The Secretary should specify that the separately payable non-pass-through policy in the hospital outpatient prospective payment system applies only to drugs and biologics that are the reason for a visit and meet a defined cost threshold.

  • Drugs, Devices, and Tests
  • Hospital

June 2021

Mandated report: Evaluating the skilled nursing facility value-based purchasing program (1)

The Congress should eliminate Medicare’s current skilled nursing facility (SNF) value-based purchasing program and establish a new SNF value incentive program (VIP) that: scores a small set of performance measures; incorporates strategies to ensure reliable measure results; establishes a system for distributing rewards that minimizes cliff effects; accounts for differences in patient social risk factors… Read more »

  • Post-acute care
  • Quality

June 2021

Mandated report: Evaluating the skilled nursing facility value-based purchasing program (2)

The Secretary should finalize development of and begin to report patient experience measures for skilled nursing facilities.

  • Post-acute care
  • Quality

June 2021

Medicare vaccine coverage and payment

The Congress should: cover all appropriate preventative vaccines and their administration under Part B instead of Part D without beneficiary cost sharing and modify Medicare’s payment rate for Part B-covered preventative vaccines to be 103 percent of wholesale acquisition cost, and require vaccine manufacturers to report average sales price data to CMS for analysis.

  • Beneficiaries and coverage
  • Drugs, Devices, and Tests

June 2021

Rebalancing Medicare Advantage benchmark policy

The Congress should replace the current Medicare Advantage (MA) benchmark policy that applies: a relatively equal blend of per capita local area fee-for-service (FFS) spending with price-standardized per capita national FFS spending; a rebate of at least 75 percent; a discount rate of at least 2 percent; and the Commission’s prior MA benchmark recommendations –… Read more »

  • Delivery system reforms
  • Part C (Medicare Advantage)

June 2021

Revising Medicare’s indirect medical education payments to better reflect teaching hospitals’ costs

The Congress should require CMS to transition to empirically justified indirect medical education adjustments to both inpatient and outpatient Medicare payments.

  • Hospital

June 2021

Streamlining CMS’s portfolio of alternative payment models

The Secretary should implement a more harmonized portfolio of fewer alternative payment models that are designed to work together to support the strategic objectives of reducing spending and improving quality

  • Delivery system reforms

June 2021

Ambulatory surgical center services (1)

For calendar year 2022, the Congress should eliminate the update to the 2021 Medicare conversion factor for ambulatory surgical centers.

  • Ambulatory care settings

March 2021

Ambulatory surgical center services (2)

The Secretary should require ambulatory surgical centers to report cost data.

  • Ambulatory care settings

March 2021