November 7-8, 2024

11/07/2024 . 10:30 am - 12:30 pm

Reforming physician fee schedule updates and improving the accuracy of payments

Staff Contacts:

ISSUE: Under current law, starting in 2026, payment rates under the physician fee schedule will increase by 0.75 percent per year for qualifying clinicians participating in advanced alternative payment models (A-APMs) and by 0.25 percent for all other clinicians.

KEY POINTS: The Commission’s annual payment adequacy analyses continue to find that Medicare beneficiaries’ access to clinician care is as good as, or better than, that of privately insured individuals. But concerns have been raised that, under current-law updates, Medicare’s payments under the physician fee schedule may not remain adequate to continue to ensure access to care for beneficiaries.

ACTION: Commissioners will discuss a policy option to update physician fee schedule rates and an option to improve the accuracy of such rates.

11/07/2024 . 1:45 pm - 3:10 pm

Considering the participation bonus for clinicians in advanced alternative payment models

Staff Contacts:

ISSUE: Historically, Medicare payment policy has given clinicians a relatively clear financial incentive to participate in advanced alternative payment models (A-APMs) rather than remain in Medicare’s Merit-based Incentive Payment System (MIPS).

KEY POINTS: Clinicians’ incentives to participate in A-APMs may become murkier beginning in 2027. The A-APM participation bonus will sunset after 2026, but counterbalancing changes that could encourage continued participation in A-APMs even in the absence of a bonus.

ACTION: Commissioners will review and discuss the material.

11/07/2024 . 3:15 pm - 4:45 pm

Structural differences between the PDP and MA–PD markets

Staff Contacts:

ISSUE: The Part D program has evolved over the two decades since its inception, and the numerous changes have altered the dynamics in the two Part D markets: the stand-alone prescription drug plan (PDP) market for fee-for-service (FFS) beneficiaries and the Medicare Advantage–Prescription Drug plan (MA–PD) market for beneficiaries who choose to enroll in Medicare Advantage (MA).

KEY POINTS: The different dynamics of the two Part D markets have important implications for plan choice, beneficiary costs, and access to medications.

ACTION: Commissioners will review the material presented and discuss future directions for this work.

11/08/2024 . 9:00 am - 10:25 am

Workplan: Assessing Medicare Advantage provider networks

Staff Contacts:

ISSUE: One key distinction between Medicare Advantage (MA) and fee-for-service (FFS) Medicare is that MA beneficiaries trade the free choice of any provider participating in Medicare for extra benefits like lower premiums and cost sharing and a more managed set of relationships with providers in an MA plan’s network.

KEY POINTS: Last cycle, the Commission reviewed CMS’s network adequacy standards for MA contracts, which consist of minimum numbers of providers, maximum travel time and distance to providers, and maximum wait times.

ACTION: Commissioners will review and discuss the work plan on MA provider networks.

11/08/2024 . 10:30 am - 12:00 pm

Medicare’s coverage limits on stays in freestanding inpatient psychiatric facilities

Staff Contacts:

ISSUE: Since its inception, Medicare has applied limits to the coverage of treatment in freestanding inpatient psychiatric facilities (IPFs)—a lifetime limit of 190 days and an initial benefit period that gets reduced based on prior use.

KEY POINTS: MedPAC analyses have shown shifts in settings of care for beneficiaries who near the 190-day limit, and that those shifts in setting are more likely to affect highly vulnerable beneficiaries.

ACTION: Commissioners will review the findings and discuss the Chair’s draft recommendation.