This Thursday, MedPAC kicks off the 2024-2025 meeting cycle when we convene our September meeting. We are excited to share some of the policy issues MedPAC will be working on during the coming months. MedPAC’s agenda is shaped by a combination of statutory requirements, congressional interest, and the interests of the Commission, at the direction of MedPAC’s Chair and Executive Director. Three core principles guide our work: (1) payments should be sufficient to support beneficiary access to high-quality health care in an appropriate clinical setting; (2) Medicare payments should reflect efficient care delivery, thereby ensuring that the program’s fiscal burden on beneficiaries and taxpayers is not greater than necessary; and (3) providers should have incentives to supply appropriate and equitable care in an efficient manner. In all our work, MedPAC follows a deliberative, analytic process to provide the Congress with thoughtful, empirically based information and advice on Medicare.
MedPAC strives for transparency by webcasting the Commission’s public meetings; publishing the transcript and presentations following such meetings; publishing online all its reports, comment letters, and congressional testimony; and, beginning in November 2023, posting on its website official comment letters submitted by interested parties within 14 days of the associated public meeting.
In this spirit of transparency, we are sharing the policy issues the Commission plans to work on in the coming months. The agenda is subject to change based on data availability and on analytic progress, the Commission’s discussions, and changing circumstances.
The Commission is required by statute to deliver two reports to the Congress each year: one by March 15th and another by June 15th. Our March report analyzes the adequacy of Medicare’s payments and makes recommendations to the Congress on whether and how those payments should be updated. Our June report focuses on broader questions affecting the Medicare program, and it too can include recommendations to the Congress for improving Medicare’s payment systems to promote beneficiary access to care and efficient use of program resources. MedPAC publishes periodic data books with information about the Medicare program, its beneficiaries, and participating providers and plans; it also writes comment letters responding to proposed rules from the Centers for Medicare & Medicaid Services. Additionally, MedPAC produces its yearly Payment Basics series that explains how different Medicare payment systems work.
In the coming months, the Commission will analyze the adequacy of Medicare’s fee-for-service (FFS) payments for hospitals, clinicians, outpatient dialysis facilities, skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and hospice agencies. The Commission also will deliver updated status reports on the Medicare Advantage (MA) and Part D programs, and on ambulatory surgical centers. These analyses will include information on Medicare payments, beneficiary access to care, and—where possible—the quality of care provided to beneficiaries.
The Commission will also continue its work assessing the MA program. The MA program has grown significantly over the past decade, and it is increasingly important to understand enrollees’ experience in the program and its effect on the federal budget. We plan to discuss how MA enrollees utilize different types of care, including post-acute care such as home health services. We will extend our work examining MA enrollees’ use of supplemental benefits, institutionalized beneficiaries enrolled in MA, how MA plans pay providers for care, MA plan provider networks and access to care, and the effect of MA plans on rural hospitals and clinics. We will also continue our analysis of risk adjustment, including assessing differential coding between MA and FFS and favorable selection into MA.
We plan to conduct our annual review of the Medicare prescription drug program (Part D), including program spending, enrollment and benefit offerings, and beneficiary cost sharing. Additionally, we plan to evaluate the stability of the stand-alone prescription drug plan (PDP) market and compare drug coverage offered by stand-alone PDPs and Medicare Advantage prescription drug plans (MA–PDs).
We are working on several other issues in the Medicare program as well, including continuing our work on approaches for updating payment rates under the physician fee schedule and incentivizing advanced alternative payment models (A–APMs) that appeared in our June 2024 report to the Congress. We will also launch new work analyzing care for Medicare beneficiaries who live in nursing homes; traditional Medicare supplemental insurance policies and coverage, with a focus on Medigap; hospice and end-of-life care for beneficiaries with end-stage renal disease (ESRD); nurse staffing levels at skilled nursing facilities; and Medicare coverage of and payment for software approved or cleared by the Food and Drug Administration. In addition, we plan to analyze Medicare’s 190-day coverage limit for inpatient psychiatric services at freestanding facilities and Medicare’s support of hospitals in rural areas, including beneficiary cost sharing for care delivered at critical access hospitals and quality measurement of rural hospitals.
Finally, the Commission will begin work on two reports that are mandated by the Bipartisan Budget Act of 2018. Over the next two cycles, we will analyze recent changes to the home health prospective payment system, including the impact of the new 30-day unit of payment, for a report that is due in March 2026. Additionally, we will begin analysis of FFS Medicare payment for ambulance services and the Ground Ambulance Data Collection System for a report that is due in June 2026.
We look forward to an exciting year ahead and hope that you will tune in to our public meetings.
