Who Oversees Medicare Costs?

The Medicare Payment Advisory Commission (MedPAC) provides cost and access oversight for the Medicare Program for quality of care and access to services.

The Balanced Budget Act of 1997 established the group, which is composed of 17 part-time members appointed for three-year terms by the Comptroller General. Some appointments expire each year. The committee’s job is to meet publicly and issue reports to Congress twice a year in March and June.It also offers comments and reports on proposed regulation testimony, and congressional staff briefings.

What Does MedPAC Do?

MedPAC is concerned with the quality of care and access to services under Medicare. It also advises Congress on payments to private health plans participating in the Medicare program and in the traditional fee-for-service Medicare program and on issues affecting Medicare. More information can be found on medpac.gov.[1]

Examples of MedPAC Documents

If you would like to see examples of recent MedPAC communications, those listed below might be of interest.

MedPAC has recently issued a letter on payments and quality controls in End Stage Renal Disease treatment. See MedPAC comment on CMS’s proposed rule on the ESRD prospective payment system and quality incentive program.[2]

The committee also issued a 200-page report in June 2017, A Data Book: Health Care Spending and the Medicare Program.[3] This is an exhaustive assessment of the goals and accomplishments of the Medicare program.

In addition, the committee studied the billing and payment protocols for skilled nursing facilities.[4]

Summary

Although MedPAC can advise Congress, its rulings do not have the force of law. IPAB, should it ever be actualized, might be able to make laws. The decision on whether or not the administrations needs two such similar organizations remains in the future.

Citations

  1. About MedPAC
  2. MedPAC comment on CMS’s proposed rule on the ESRD prospective payment system and quality incentive program
  3. A Data Book: Health Care Spending and the Medicare Program
  4. MedPAC comment on CMS’s advance notice of proposed rulemaking on revisions to the SNF PPS