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 servicesFor calendar year 2022, the Congress should eliminate the update to the 2021 Medicare end-stage renal disease prospective payment system base rate. |
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March 2021 |
Physician and other health professional servicesFor calendar year 2022, the Congress should update the 2021 Medicare payment rates for physician and other health professional services by the amounts determined under current law. |
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March 2021 |
Skilled nursing facility servicesFor fiscal year 2022, the Congress should eliminate the update to the 2021 Medicare base payment rates for skilled nursing facilities. |
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March 2021 |
Challenges in maintaining and increasing savings from accountable care organizationsThe Secretary should use the same set of national provider identifiers to compute both performance-year and baseline assignment for accountable care organizations in the Medicare Shared Savings Program. |
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June 2020 |
Improving Medicare’s end-stage renal disease prospective payment system (1)The Congress should direct the Secretary to eliminate the end-stage renal disease prospective payment system’s transitional drug add-on payment adjustment for new drugs in an existing end-stage renal disease functional category. |
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June 2020 |
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. |
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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 » |
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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 » |
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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. |
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June 2020 |
Replacing the Medicare Advantage quality bonus programThe 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 » |
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June 2020 |