October 10-11, 2024

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

Medicare beneficiaries in nursing homes

Staff Contacts:

ISSUE: About 1.2 million Medicare beneficiaries live in nursing homes due to functional and/or cognitive impairments that prevent them from living in the community. There have been long-running concerns about the quality of care that nursing home residents receive.

KEY POINTS: Compared with other Medicare beneficiaries, those living in nursing homes are older and have higher Medicare spending. The nursing home industry has about 15,000 facilities; nearly all participate in both Medicare and Medicaid, and about 70 percent are for profit.

ACTION: Commissioners will discuss potential future directions for work related to this population.

10/10/2024 . 1:15 pm - 2:45 pm

Findings from MedPAC’s annual beneficiary and provider focus groups

Staff Contacts:

ISSUE: Understanding the experiences and perspectives of Medicare beneficiaries and clinicians is central to the Commission’s work. Each year, MedPAC conducts focus groups aimed at gathering more qualitative descriptions of beneficiaries’ and clinicians’ experiences with the Medicare program.

KEY POINTS: In May and June of 2024, we conducted in-person focus groups in three metropolitan areas with beneficiaries and clinicians and virtual focus groups with rural beneficiaries.

ACTION: Commissioners will discuss the findings and provide feedback on future qualitative work.

10/10/2024 . 2:50 pm - 4:30 pm

Supplemental benefits in Medicare Advantage

Staff Contacts:

ISSUE: In addition to covering Part A and Part B services, Medicare Advantage (MA) plans may provide supplemental benefits to their enrollees, such as reduced cost sharing for Part A and Part B services, reduced Part B and Part D premiums, and other services not covered under FFS Medicare such as dental, vision, or hearing services. These supplemental benefits are a defining feature of MA, but relatively little is known about enrollees’ use of the benefits and spending associated with them.

KEY POINTS: The majority of the supplemental benefits provided by MA plans are financed by the rebates that plans receive from Medicare. Medicare’s rebates to MA plans have increased sharply in recent years. At the same time, CMS and the Congress have gradually increased plans’ flexibility in the types of supplemental benefits that can be offered and how the benefits can be offered. These new flexibilities, combined with the growth in rebate dollars, have allowed MA plans to significantly expand the number of extra benefits they offer. However, the available data are insufficient for examining enrollees’ use of supplemental benefits.

ACTION: Commissioners will review information about MA plans’ reporting of supplemental benefits and discuss future work on enrollees’ use of supplemental benefits.

10/11/2024 . 9:00 am - 9:55 am

Work plan for a mandated final report on the impact of recent changes to the home health prospective payment system

Staff Contacts:

ISSUE: The Bipartisan Budget Act (BBA) of 2018 requires the Commission to assess the impact of recent changes to the home health prospective payment system (PPS) on agency payments and costs, the delivery of care, and quality of care and provide an interim and a final report to Congress.

KEY POINTS: In 2020, CMS implemented major changes to the home health PPS, as required by BBA 2018. These included a new 30-day period as the unit of payment (replacing the 60-day unit) and a new patient classification system called the Patient-Driven Groupings model, which eliminated the number of in-person therapy visits as a factor in the payment system. In March 2022, the Commission submitted a mandated interim report to the Congress, which described recent changes in use and costs of care but noted that any observed initial impact of the new payment system was confounded by the disruptions associated with the coronavirus public health emergency. The Commission’s final report is due on March 15, 2026.

ACTION: Commissioners will review the findings from the MedPAC’s interim report and discuss the proposed workplan for the final report.

10/11/2024 . 10:00 am - 11:30 am

Initial estimates of home health care use among Medicare Advantage enrollees

Staff Contacts:

ISSUE: Commissioners have expressed interest in understanding home health care use among Medicare Advantage (MA) enrollees, who now account for half of Medicare beneficiaries.

KEY POINTS: Multiple studies have used Medicare’s home health Outcomes and Assessment Information Set (OASIS) data to examine home health use among MA enrollees, but it is difficult to draw conclusions from these studies because OASIS data contain no information on the number, length, or type of home health visits that beneficiaries receive. MA encounter data could allow a better understanding of service use among MA enrollees nationwide.

ACTION: Commissioners will review and discuss findings on the use of home health care by MA enrollees and provide feedback on future work.