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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

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

Replacing the Medicare Advantage quality bonus program

The Congress should replace the current Medicare Advantage (MA) quality bonus program with a new MA value incentive program that: scores a small set of population-based measures; evaluates quality at the local market level; uses a peer-grouping mechanism to account for differences in enrollees’ social risk factors; establishes a system for distributing rewards with no… Read more »

  • Part C (Medicare Advantage)
  • Quality

June 2020

Ensuring the accuracy and completeness of Medicare Advantage encounter data

The Congress should direct the Secretary to establish thresholds for the completeness and accuracy of Medicare Advantage (MA) encounter data and: rigorously evaluate MA organizations’ submitted data and provide robust feedback; concurrently apply a payment withhold and provide refunds to MA organizations that meet thresholds; and institute a mechanism for direct submission of provider claims… Read more »

  • Part C (Medicare Advantage)

June 2019

The Medicare Advantage program: Status report (1)

For Medicare Advantage contract consolidations involving different geographic areas, the Secretary should: for any consolidations effective on or after January 1, 2018, require companies to report quality measures using the geographic reporting units and definitions as they existed prior to consolidation, and determine star ratings as though the consolidations had not occurred, and maintain the… Read more »

  • Part C (Medicare Advantage)
  • Quality

March 2018

The Medicare Advantage program: Status report (2)

The Secretary should: establish geographic areas for Medicare Advantage quality reporting that accurately reflect health care market areas, and calculate star ratings for each contract at the geographic level for public reporting and for the determination of quality bonuses.

  • Part C (Medicare Advantage)
  • Quality
  • Regional issues

March 2018

Status report on the Medicare Advantage program

The Secretary should calculate Medicare Advantage benchmarks using fee-for-service spending data only for beneficiaries enrolled in both Part A and Part B.

  • Part C (Medicare Advantage)

March 2017

The Medicare Advantage program: Status report (1)

The Congress should eliminate the cap on benchmark amounts and the doubling of the quality increases in specified counties.

  • Part C (Medicare Advantage)
  • Quality

March 2016

The Medicare Advantage program: Status report (2)

The Congress should direct the Secretary to: develop a risk adjustment model that uses two years of fee-for-service (FFS) and Medicare Advantage (MA) diagnostic data and does not include diagnoses from health risk assessments from either FFS or MA, and then apply a coding adjustment that fully accounts for the remaining differences in coding between… Read more »

  • Part C (Medicare Advantage)

March 2016

The Medicare Advantage program: Status report (1)

The Congress should direct the Secretary to determine payments for employer group Medicare Advantage plans in a manner more consistent with the determination of payments for comparable non-employer plans.

  • Part C (Medicare Advantage)

March 2014

The Medicare Advantage program: Status report (2)

The Congress should include the Medicare hospice benefit in the Medicare Advantage benefits package beginning in 2016.

  • Part C (Medicare Advantage)

March 2014