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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
Outpatient dialysis services (2) The Congress should direct the Secretary to: * include a measure that assesses poor outcomes related to anemia in the End-Stage Renal Disease Quality Incentive Program. * redesign the low-volume payment adjustment to consider a facility’s distance to the nearest facility. * audit dialysis facilities’ cost report data.	Ambulatory care settings Quality	March 2014
Mandated report: Improving Medicare’s payment system for outpatient therapy services (1) The Congress should direct the Secretary to: reduce the certification period for the outpatient therapy plan of care from 90 days to 45 days, and develop national guidelines for therapy services, implement payment edits at the national level based on these guidelines that target implausible amounts of therapy, and use authorities granted by the Patient… Read more »	Ambulatory care settings	June 2013
Mandated report: Improving Medicare’s payment system for outpatient therapy services (2) To avoid caps without exceptions, the Congress should: reduce the therapy cap for physical therapy and speech-language pathology services combined and the separate cap for occupational therapy to $1,270 in 2013. These caps should be updated each year by the Medicare Economic Index. direct the Secretary to implement a manual review process for requests to… Read more »	Ambulatory care settings Beneficiaries and coverage Physicians and other health professionals	June 2013
Mandated report: Improving Medicare’s payment system for outpatient therapy services (3) The Congress should direct the Secretary to: prohibit the use of V codes as the principal diagnosis on outpatient therapy claims, and collect functional status information on therapy users using a streamlined, standardized, assessment tool that reflects factors such as patients’ demographic information, diagnoses, medications, surgery, and functional limitations to classify patients across all therapy… Read more »	Ambulatory care settings	June 2013
Medicare payment for ambulance services (1) The Congress should: allow the three temporary ambulance add-on policies to expire; direct the Secretary to rebalance the relative values for ambulance services by lowering the relative value of basic life support nonemergency services and increasing the relative values of other ground transports. Rebalancing should be budget neutral relative to current law and maintain payments… Read more »	Ambulatory care settings	June 2013
Medicare payment for ambulance services (2) The Congress should direct the Secretary to: promulgate national guidelines to more precisely define medical necessity requirements for both emergency and nonemergency (recurring and nonrecurring) ground ambulance transport services; develop a set of national edits based on those guidelines to be used by all claims processors; and identify geographic areas and/or ambulance suppliers and providers… Read more »	Ambulatory care settings	June 2013
Ambulatory surgical center services The Congress should eliminate the update to the payment rates for ambulatory surgical centers for calendar year 2014. The Congress should also require ambulatory surgical centers to submit cost data.	Ambulatory care settings	March 2013
Outpatient dialysis services The Congress should not increase the outpatient dialysis bundled payment rate for calendar year 2014.	Ambulatory care settings	March 2013
Ambulatory surgical center services (1) The Congress should update the payment rates for ambulatory surgical centers by 0.5 percent for calendar year 2013. The Congress should also require ambulatory surgical centers to submit cost data.	Ambulatory care settings	March 2012
Ambulatory surgical center services (2) The Congress should direct the Secretary to implement a value-based purchasing program for ambulatory surgical center services no later than 2016.	Ambulatory care settings Quality	March 2012