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.
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Using payment to ensure appropriate access to and use of hospital emergency department services (1)The Congress should: allow isolated rural stand-alone emergency departments (more than 35 miles from another emergency department) to bill standard outpatient prospective payment system facility fees and provide such emergency departments with annual payments to assist with fixed costs. |
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Using payment to ensure appropriate access to and use of hospital emergency department services (2)The Congress should reduce Type A emergency department rates by 30 percent for off-campus stand-alone emergency departments that are within six miles of an on-campus hospital emergency department. |
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Hospital inpatient and outpatient servicesFor 2019, the Congress should update the 2018 Medicare base payment rates (inpatient and outpatient) for acute care hospitals by the amount determined under current law. |
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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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Hospital inpatient and outpatient services (2)The Congress should update the inpatient and outpatient payments by the amounts specified in current law |
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Hospital inpatient and outpatient servicesThe Congress should direct the Secretary of the Department of Health and Human Services to: update inpatient and outpatient payments by the amount specified in current law; reduce Medicare payment rates for 340B hospitals’ separately payable Part B drugs by 10 percent of the average sales price; direct the program savings from reducing Part B… Read more » |
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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 » |
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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. |
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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. |
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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 » |
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