MedPAC’s January 2025 public meeting was held via live webcast.
Agenda
01/16/2025 . 10:15 am - 10:45 am
Assessing payment adequacy and updating payments: Physician and other health professional services
Staff Contacts:
ISSUE: By law, each year the Commission reviews Medicare’s FFS payment policies and makes payment update recommendations. We consider whether payments to physicians and other health professionals under the physician fee schedule (PFS) are adequate and how they should be updated in 2026.
KEY POINTS: Last month, Commissioners examined information on beneficiaries’ access to care, quality of care, and clinicians’ revenues and costs, and discussed the Chair’s draft update recommendation.
ACTION: Commissioners will review the findings and vote on the draft update recommendation.
01/16/2025 . 10:50 am - 11:20 am
Assessing payment adequacy and updating payments: Hospital inpatient and outpatient services
Staff Contacts:
ISSUE: By law, each year the Commission reviews Medicare’s FFS payment policies and makes payment update recommendations. We consider whether inpatient and outpatient payments to hospitals are adequate and how they should be updated in 2026. Beginning in March 2024, the Commission is also required to report annually on payments to rural emergency hospitals (REHs).
KEY POINTS: Last month, Commissioners examined information on FFS beneficiaries’ access to hospital care, quality of care, hospitals’ access to capital, and the relationship between FFS Medicare payments and hospitals’ costs, as well as information on REHs, and discussed the Chair’s draft update recommendation.
ACTION: Commissioners will review the findings and vote on the draft update recommendation.
01/16/2025 . 11:25 am - 12:00 pm
Assessing payment adequacy and updating payments: Skilled nursing facility services; home health agency services; inpatient rehabilitation facility services; outpatient dialysis services; and hospice services
Staff Contacts:
ISSUE: By law, each year the Commission reviews Medicare’s FFS payment policies and makes payment update recommendations. We consider whether payments to skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, dialysis facilities, and hospices are adequate and how they should be updated in 2026.
KEY POINTS: Last month, for each of these settings, Commissioners examined information on beneficiaries’ access to care and quality of care, providers’ access to capital, and the relationship between Medicare’s FFS payments and providers’ costs, and discussed the Chair’s draft update recommendations.
ACTION: Commissioners will review the findings and vote on the draft update recommendations.
01/16/2025 . 1:10 pm - 1:55 pm
Eliminating Medicare’s coverage limits on stays in freestanding inpatient psychiatric facilities
Staff Contacts:
ISSUE: Medicare applies limits to the coverage of treatment in inpatient psychiatric facilities (IPFs)—a lifetime limit of 190 days at freestanding IPFs and a reduction to a beneficiary’s initial benefit period depending on prior use of freestanding IPF care. In response to a Congressional request, the Commission reported in June 2023 on the use and availability of behavioral health services for Medicare beneficiaries, including the impact of the 190-day lifetime limit on freestanding IPF use.
KEY POINTS: In the fall, commissioners examined results showing shifts in settings of care for beneficiaries who near the 190-day limit and discussed the Chair’s draft recommendation to eliminate coverage limits on IPF care.
ACTION: Commissioners will review the findings and vote on the draft recommendation.
01/16/2025 . 2:00 pm - 3:25 pm
Medicare prescription drug program (Part D): Status report
Staff Contacts:
ISSUE: Each year we present findings on the status of Medicare’s Part D program.
KEY POINTS: MedPAC’s status report provides the most recent available information on Part D enrollment, plan offerings, premiums, utilization, and other aspects of the program, including the significant changes being implemented in 2025 and beyond.
ACTION: Commissioners will review and discuss the findings.
01/16/2025 . 3:30 pm - 4:30 pm
Ambulatory surgical center services: Status report
Staff Contacts:
ISSUE: Each year since 2023, we present findings on the status of Medicare’s payment system for ambulatory surgical centers (ASCs).
KEY POINTS:Staff will provide a status report on ASC supply, volume of services provided to FFS beneficiaries, and Medicare spending.
ACTION: Commissioners will review and discuss the findings.
01/17/2025 . 8:30 am - 10:25 am
The Medicare Advantage program: Status report
Staff Contacts:
ISSUE: Each year, we present findings on the status of the Medicare Advantage (MA) program.
KEY POINTS: We present the most recent information on MA enrollment and beneficiary access to plans, plan rebates and supplemental benefits, MA market structure, Medicare payments to plans, plan coding practices, favorable selection, and plan quality.
ACTION: Commissioners will review and discuss the findings.
01/17/2025 . 10:30 am - 12:00 pm
Reducing beneficiary cost-sharing for outpatient services at critical access hospitals
Staff Contacts:
ISSUE: The critical access hospital (CAH) program, enacted by the Congress in 1997, provides cost-based Medicare payments to certain rural hospitals with 25 or fewer beds. Beneficiary cost-sharing liability for most fee-for-service Medicare outpatient services at CAHs also higher than at other hospitals, since it is set at 20 percent of charges, rather than 20 percent of the Medicare payment amount.
KEY POINTS: In September 2024, staff presented results from an analysis that showed that outpatient cost-sharing liability at CAHs averaged about half of total Medicare payments for those services in 2022 and varied widely due to differences in markups across CAHs and across services within CAHs.
ACTION: Commissioners will review CAH cost-sharing policies and discuss the Chair’s draft recommendation to modify cost-sharing liability for beneficiaries who receive care at CAHs.