CHA News Article

MedPAC, MACPAC Issue June Reports to Congress
For Reimbursement Staff, Post-Acute Care Executives

The Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC) have issued their June 2019 reports to Congress.

The MedPAC report evaluates Medicare payment issues, changes in health care delivery, and the market for health care services. The MACPAC report includes analysis of payment for safety-net hospitals, coverage of and spending on outpatient prescription drugs, and state efforts to promote program integrity. Both MedPAC and MACPAC serve in an advisory role to Congress, and their recommendations cannot be implemented without congressional or administrative action. Key recommendations are outlined below.

MedPAC Recommendations

  • Require advanced practice registered nurses and physician assistants to bill the Medicare program directly, eliminating “incident to” billing for services they provide. Refine Medicare specialty designations for these professionals.
  • By 2022, develop and implement a set of national guidelines for coding hospital emergency department visits under the outpatient prospective payment system.
  • Establish thresholds for the completeness and accuracy of Medicare Advantage (MA) encounter data; evaluate MA organizations’ submitted data and provide robust feedback; apply a payment withhold and provide refunds to MA organizations that meet defined thresholds; and institute a mechanism for direct submission of provider claims to Medicare administrative contractors.

In addition to the recommendations, MedPAC further examines payment issues in post-acute care, including stay-based versus episode-based designs, functional assessment data, and approaches for establishing aligned requirements for providers under a post-acute care prospective payment system.

MACPAC Recommendations

  • Change the statutory definition of Medicaid shortfall to exclude costs and payments for all Medicaid-eligible patients for whom Medicaid is not the primary payer.
  • Eliminate the cap on rebates for outpatient prescription drugs.
  • Examine current state Medicaid program integrity activities and provide states with flexibility in choosing program integrity strategies that are effective and demonstrate high value.