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 |
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Moving beyond the Merit-based Incentive Payment SystemThe Congress should: eliminate the current Merit-based Incentive Payment System; and establish a new voluntary value program in fee-for-service Medicare in which: clinicians can elect to be measured as part of a voluntary group; and clinicians in voluntary groups can qualify for a value payment based on their group’s performance on a set of population-based… Read more » |
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Outpatient dialysis servicesFor 2019, the Congress should update the calendar year 2018 Medicare end-stage renal disease prospective payment system base rate by the amount determined under current law. |
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Physician and other health professional servicesFor calendar year 2019, the Congress should increase the calendar year 2018 payment rates for physician and other health professional services by the amount specified in current law. |
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Post-acute care: Increasing the equity of Medicare’s payments within each settingThe Congress should direct the Secretary to begin to base Medicare payments to post-acute care (PAC) providers on a blend of each sector’s setting-specific relative weights and the unified PAC prospective payment system’s relative weights in fiscal year 2019. |
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Skilled nursing facility servicesThe Congress should: eliminate the market basket update for skilled nursing facilities for fiscal years 2019 and 2020; direct the Secretary to implement a redesigned prospective payment system (PPS) in fiscal year 2019 for skilled nursing facilities; and direct the Secretary to report to the Congress on the impacts of the revised PPS and make… Read more » |
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The Medicare Advantage program: Status report (1)For Medicare Advantage contract consolidations involving different geographic areas, the Secretary should: for any consolidations effective on or after January 1, 2018, require companies to report quality measures using the geographic reporting units and definitions as they existed prior to consolidation, and determine star ratings as though the consolidations had not occurred, and maintain the… Read more » |
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The Medicare Advantage program: Status report (2)The Secretary should: establish geographic areas for Medicare Advantage quality reporting that accurately reflect health care market areas, and calculate star ratings for each contract at the geographic level for public reporting and for the determination of quality bonuses. |
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The Medicare prescription drug program (Part D): Status reportThe Congress should change Part D’s coverage-gap discount to: require manufacturers of biosimilar products to pay the coverage-gap discount by including biosimilars in the definition of “applicable drugs” and exclude biosimilar manufacturers’ discounts in the coverage gap from enrollees’ true out-of-pocket spending. |
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Implementing a unified payment system for post-acute careThe Congress should direct the Secretary to: implement a prospective payment system for post-acute care beginning in 2021 with a three year transition; lower aggregate payments by 5 percent, absent prior reductions to the level of payments; concurrently, begin to align setting-specific regulatory requirements; and periodically revise and rebase payments, as needed, to keep payments… Read more » |
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Medicare Part B drug payment policy issuesThe Congress should change Medicare’s payment for Part B drugs and biologicals (products) as follows: Modify the average sales price (ASP) system in 2018 to: require all manufacturers of products paid under Part B to submit ASP data and impose penalties for failure to report. reduce wholesale acquisition cost (WAC)-based payment to WAC plus 3… Read more » |
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