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 |
|---|---|---|
Skilled nursing facility servicesThe Congress should: eliminate the market basket update for skilled nursing facilities for fiscal years 2019 and 2020; direct the Secretary to implement a redesigned prospective payment system (PPS) in fiscal year 2019 for skilled nursing facilities; and direct the Secretary to report to the Congress on the impacts of the revised PPS and make… Read more » |
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March 2018 |
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 » |
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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. |
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March 2018 |
The Medicare prescription drug program (Part D): Status reportThe Congress should change Part D’s coverage-gap discount to: require manufacturers of biosimilar products to pay the coverage-gap discount by including biosimilars in the definition of “applicable drugs” and exclude biosimilar manufacturers’ discounts in the coverage gap from enrollees’ true out-of-pocket spending. |
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March 2018 |
Implementing a unified payment system for post-acute careThe Congress should direct the Secretary to: implement a prospective payment system for post-acute care beginning in 2021 with a three year transition; lower aggregate payments by 5 percent, absent prior reductions to the level of payments; concurrently, begin to align setting-specific regulatory requirements; and periodically revise and rebase payments, as needed, to keep payments… Read more » |
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June 2017 |
Medicare Part B drug payment policy issuesThe Congress should change Medicare’s payment for Part B drugs and biologicals (products) as follows: Modify the average sales price (ASP) system in 2018 to: require all manufacturers of products paid under Part B to submit ASP data and impose penalties for failure to report. reduce wholesale acquisition cost (WAC)-based payment to WAC plus 3… Read more » |
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June 2017 |
Ambulatory surgical care servicesThe Congress should eliminate the update to the payment rates for ambulatory surgical centers for calendar year 2018. The Congress should also require ambulatory surgical centers to submit cost data |
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March 2017 |
Home health care servicesThe Congress should reduce home health payment rates by 5 percent in 2018 and implement a two-year rebasing of the payment system beginning in 2019. The Congress should direct the Secretary to revise the prospective payment system to eliminate the use of the number of therapy visits as a factor in payment determinations, concurrent with… Read more » |
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March 2017 |
Hospice servicesThe Congress should eliminate the update to the hospice payment rates for fiscal year 2018. |
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March 2017 |
Hospital inpatient and outpatient services (1)The Secretary should require hospitals to add a modifier on claims for all services provided at off-campus stand-alone emergency department facilities. |
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March 2017 |