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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
Improving Medicare’s end-stage renal disease prospective payment system (2) The Secretary should replace the current low-volume and rural payment adjustments in the end-stage renal disease prospective payment system with a single adjustment for dialysis facilities that are isolated and consistently have low volume, where low-volume criteria are empirically derived.	Ambulatory care settings Regional issues	June 2020
Realigning incentives in Medicare Part D (1) The Congress should make the following changes to the Part D prescription drug benefit: Below the out-of-pocket threshold: Eliminate the initial coverage limit. Eliminate the coverage-gap discount program. Above the out-of-pocket threshold: Eliminate enrollee cost sharing. Transition Medicare’s reinsurance subsidy from 80 percent to 20 percent. Require pharmaceutical manufacturers to provide a discount equal to… Read more »	Beneficiaries and coverage Drugs, Devices, and Tests	June 2020
Realigning incentives in Medicare Part D (2) Concurrent with our recommended changes to the benefit design, the Congress should: Establish a higher copayment amount under the low-income subsidy for nonpreferred and nonformulary drugs. Give plan sponsors greater flexibility to manage the use of drugs in the protected classes. Modify the program’s risk corridors to reduce plans’ aggregate risk during the transition to… Read more »	Beneficiaries and coverage Drugs, Devices, and Tests	June 2020
Realigning incentives in Medicare Part D (3) Concurrent with our recommended changes to the benefit design, the Secretary should: Allow plans to establish preferred and nonpreferred tiers for specialty-tier drugs. Recalibrate Part D’s risk adjusters to reflect the higher benefit liability that plans bear under the new benefit structure.	Beneficiaries and coverage Drugs, Devices, and Tests	June 2020
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
Ambulatory surgical center services The Secretary should also require ambulatory surgical centers to report cost data. For calendar year 2021, in the absence of cost data, the Congress should eliminate the update to the calendar year 2020 Medicare conversion factor for ambulatory surgical centers.	Ambulatory care settings	March 2020
Home health care services For 2021, the Congress should reduce the calendar year 2020 Medicare base payment rate for home health agencies by 7 percent.	Post-acute care	March 2020
Hospice services The Congress should: for 2021, eliminate the update to the FY 2020 Medicare base payment rates for hospice, and wage adjust and reduce the hospice aggregate cap by 20 percent.	Post-acute care	March 2020
Hospital inpatient and outpatient services The Congress should: For 2021, update the 2020 Medicare base payment rates for acute care hospitals by 2 percent; and Provide hospitals with an amount equal to the difference between the update recommendation and the amount specified in current law through the Commission’s recommended hospital value incentive program (HVIP)	Hospital Quality	March 2020
Inpatient rehabilitation facility services For fiscal year 2021, the Congress should reduce the fiscal year 2020 Medicare base payment rate for inpatient rehabilitation facilities by 5 percent. Additionally, the Commission reiterates its March 2016 recommendations on the inpatient rehabilitation facility prospective payment system.	Post-acute care	March 2020