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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

Outpatient dialysis services

The Congress should increase the outpatient dialysis base payment rate by the update specified in current law for calendar year 2017.

  • Ambulatory care settings

March 2016

Physician and other health professional services

The Congress should increase payment rates for physician and other health professional services by the amount specified in current law for calendar year 2017.

  • Physicians and other health professionals

March 2016

Skilled nursing facility services

The Congress should eliminate the market basket update for skilled nursing facilities for fiscal years 2017 and 2018 and direct the Secretary to revise the prospective payment system (PPS) for skilled nursing facilities. In 2019, the Secretary should report to the Congress on the effects of the reformed PPS and make any additional adjustments to… Read more »

  • Delivery system reforms
  • Post-acute care

March 2016

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

Hospital short-stay policy issues (1)

The Secretary should: direct recovery audit contractors (RACs) to focus reviews of short inpatient stays on hospitals with the highest rates of this type of stay, modify each RAC’s contingency fees to be based, in part, on its claim denial overturn rate, ensure that the RAC look-back period is shorter than the Medicare rebilling period… Read more »

  • Hospital

June 2015

Hospital short-stay policy issues (2)

The Secretary should evaluate establishing a penalty for hospitals with excess rates of short inpatient stays to substitute, in whole or in part, for recovery audit contractor review of short inpatient stays.

  • Hospital

June 2015

Hospital short-stay policy issues (3)

The Congress should revise the skilled nursing facility three-inpatient-day hospital eligibility requirement to allow for up to two outpatient observation days to count toward meeting the criterion.

  • Hospital
  • Post-acute care

June 2015

Hospital short-stay policy issues (4)

The Congress should require acute-care hospitals to notify beneficiaries placed in outpatient observation status that their observation status may affect their financial liability for skilled nursing facility care. The notice should be provided to patients in observation status for more than 24 hours and who are expected to need skilled nursing services. The notice should… Read more »

  • Hospital
  • Post-acute care

June 2015

Hospital short-stay policy issues (5)

The Congress should package payment for self-administered drugs provided during outpatient observation on a budget-neutral basis within the hospital outpatient prospective payment system.

  • Drugs, Devices, and Tests

June 2015