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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)	Date
Inpatient rehabilitation facility services For fiscal year 2022, the Congress should reduce the 2021 Medicare base payment rate for inpatient rehabilitation facilities by 5 percent.	Post-acute care	March 2021
Long-term care hospital services For fiscal year 2022, the Secretary should increase the 2021 Medicare base payment rate for long-term care hospitals by 2 percent.	Post-acute care	March 2021
Outpatient dialysis services For calendar year 2022, the Congress should eliminate the update to the 2021 Medicare end-stage renal disease prospective payment system base rate.	Ambulatory care settings	March 2021
Physician and other health professional services For calendar year 2022, the Congress should update the 2021 Medicare payment rates for physician and other health professional services by the amounts determined under current law.	Physicians and other health professionals	March 2021
Skilled nursing facility services For fiscal year 2022, the Congress should eliminate the update to the 2021 Medicare base payment rates for skilled nursing facilities.	Post-acute care	March 2021
Challenges in maintaining and increasing savings from accountable care organizations The Secretary should use the same set of national provider identifiers to compute both performance-year and baseline assignment for accountable care organizations in the Medicare Shared Savings Program.	Delivery system reforms	June 2020
Improving Medicare’s end-stage renal disease prospective payment system (1) The Congress should direct the Secretary to eliminate the end-stage renal disease prospective payment system’s transitional drug add-on payment adjustment for new drugs in an existing end-stage renal disease functional category.	Ambulatory care settings	June 2020
Improving Medicare’s end-stage renal disease prospective payment system (2) The Secretary should replace the current low-volume and rural payment adjustments in the end-stage renal disease prospective payment system with a single adjustment for dialysis facilities that are isolated and consistently have low volume, where low-volume criteria are empirically derived.	Ambulatory care settings Regional issues	June 2020
Realigning incentives in Medicare Part D (1) The Congress should make the following changes to the Part D prescription drug benefit: Below the out-of-pocket threshold: Eliminate the initial coverage limit. Eliminate the coverage-gap discount program. Above the out-of-pocket threshold: Eliminate enrollee cost sharing. Transition Medicare’s reinsurance subsidy from 80 percent to 20 percent. Require pharmaceutical manufacturers to provide a discount equal to… Read more »	Beneficiaries and coverage Drugs, Devices, and Tests	June 2020
Realigning incentives in Medicare Part D (2) Concurrent with our recommended changes to the benefit design, the Congress should: Establish a higher copayment amount under the low-income subsidy for nonpreferred and nonformulary drugs. Give plan sponsors greater flexibility to manage the use of drugs in the protected classes. Modify the program’s risk corridors to reduce plans’ aggregate risk during the transition to… Read more »	Beneficiaries and coverage Drugs, Devices, and Tests	June 2020