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) | Publication |
|---|---|---|
Increasing participation in the Medicare Savings Programs and the low-income drug subsidy (3)The Congress should change program requirements so that the Social Security Administration screens low-income drug subsidy applicants for federal Medicare Savings Program eligibility and enrolls them if they qualify. |
|
|
Part D enrollment, benefit offerings, and plan paymentsThe Congress should direct the Secretary to make Part D claims data available regularly and in a timely manner to congressional support agencies and selected executive branch agencies for purposes of program evaluation, public health, and safety. |
|
|
Issues in Medicare coverage of drugs (A)The Congress should direct CMS to identify selected overlap drugs and direct plans to always cover them under Part D. Identified drugs should be: * Low cost * Covered under Part D most of the time. |
|
|
Issues in Medicare coverage of drugs (B)The Congress should allow plans to cover a transitional supply of overlap drugs under Part D under the same conditions as the general transition policy applied by CMS. |
|
|
Issues in Medicare coverage of drugs (C)The Congress should permit coverage for appropriate preventive vaccines under Medicare Part B instead of Part D. |
|
|
Monitoring the implementation of Part DThe Secretary should have a process in place for timely delivery of Part D data to congressional support agencies to enable them to report to the Congress on the drug benefit’s impact on cost, quality, and access. |
|
|
Payment for pharmacy handling costs in hospital outpatient departments (A)The Secretary should establish separate, budget-neutral payments to cover the costs that hospitals incur for handling separately paid drugs, biologicals, and radiopharmaceuticals. |
|
|
Payment for pharmacy handling costs in hospital outpatient departments (B)The Secretary should: * Define a set of handling fee APCs that group drugs, biologicals, and radiopharmaceuticals based on attributes of the products that affect handling costs; * Instruct hospitals to submit charges for those APCs; and * Base payment rates for the handling fee APCs on submitted charges, reduced to costs. |
|
|
Strategies to improve care: Pay for performance and information technology (G)CMS should ensure that the prescription claims data from the Part D program are available for assessing the quality of pharmaceutical and physician care. |
|
|
Payment for new technologies in Medicare’s prospective payment systemsThe Secretary should introduce clinical criteria for eligibility of drugs and biologicals to receive pass-through payments under the outpatient prospective payment system. |
|