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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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. |
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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. |
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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. |
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Medicare coverage of clinical pharmacists’ servicesThe Secretary should assess models for collaborate drug therapy management services in outpatient settings. |
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Paying for new technology in the outpatient prospective payment system (A)The Congress should: * Replace hospital-specific payments for pass-through devices with national rates. * Give the Secretary authority to consider alternatives to average wholesale price when determining payments for pass-through drugs and biologicals. |
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Paying for new technology in the outpatient prospective payment system (B)The Secretary should: * Ensure additional payments are made only for new or substantially improved technologies that are expensive in relation to the applicable ambulatory payment classification payment rate. * Avoid basing national rates only on reported costs. * Ensure that the same broad principles guide payments for new technologies in the inpatient and outpatient… Read more » |
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Accounting for new technology in hospital prospective payment systems (A)In the outpatient payment system, pass-through payments for specific technologies should be made only when a technology is new or substantially improved and adds substantially to the cost of care in an ambulatory payment classification group. |
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Accounting for new technology in hospital prospective payment systems (C)Pass-through payments in the outpatient payment system should be made on a budget-neutral basis and the costs of new or substantially improved technologies should be factored into the update to the outpatient conversion factor. |
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