April 11, 2019

MedPAC Recommends Administrative Changes to Medicare Advantage

At its April 2019 meeting, the Medicare Payment Advisory Commission (MedPAC) recommended that Congress move forward with changes to rules governing Medicare Advantage.

Commissioners voted to recommend that the Centers for Medicare and Medicaid Services (CMS) use a payment withhold to incentivize Medicare Advantage plans to submit correct and comprehensive encounter data. The commissioners recommended the withholding begin in 2021.

The MedPAC staff presented four scenarios for CMS to shift from traditional fee-for-service (FFS) to value-based payment arrangements. They are as follows:

  1. Medicare continues to operate the traditional FFS program with voluntary provider participation in Medicare Advantage and Accountable Care Organizations (ACOs)
  2. Medicare requires all FFS providers to participate in ACOs to receive FFS payments
  3. Medicare stops paying providers directly, and Medicare Advantage plans and ACOs would pay providers for all services
  4. Medicare stops producing the FFS fee schedules

Commissioners then disagreed on how to proceed but seemed to be most supportive of exploring scenario two. They supported the notion of moving toward value-based payment but did not want to rush to make recommendations without a solid policy. If the MedPAC was to make a formal recommendation, its implementation would require legislation passed by Congress and signed by the president.