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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Long-term care hospital servicesFor fiscal year 2023, the Secretary should increase the 2022 Medicare base payment rate for long-term care hospitals by the estimate of market basket minus the applicable productivity adjustment. |
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Hospice services (1)For fiscal year 2023, the Congress should eliminate the update to the 2022 Medicare base payment rates for hospice and wage adjust and reduce the hospice aggregate cap by 20 percent. |
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Hospice services (2)The Secretary should require that hospices report telehealth services on Medicare claims. |
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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. |
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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. |
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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 » |
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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. |
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Medicare vaccine coverage and paymentThe 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. |
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Rebalancing Medicare Advantage benchmark policyThe 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 » |
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Revising Medicare’s indirect medical education payments to better reflect teaching hospitals’ costsThe Congress should require CMS to transition to empirically justified indirect medical education adjustments to both inpatient and outpatient Medicare payments. |
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