MedPAC Unveils Ambitious 2025-2026 Agenda: Scrutiny on Medicare Payments, MA Growth, and Drug Costs
MedPAC kicks off its 2025-2026 meeting cycle, detailing comprehensive plans to analyze Medicare payments, Medicare Advantage, Part D, and program sustainability.
MedPAC Sets Comprehensive Analytic Course for 2025-2026 Meeting Cycle
This week marks the commencement of the Medicare Payment Advisory Commission's (MedPAC) 2025-2026 meeting cycle, initiating a period of in-depth scrutiny into critical facets of the Medicare program. The inaugural September public meeting will feature a prominent presentation by Gene Dodaro, the Comptroller General of the United States and the head of the U.S. Government Accountability Office (GAO). Mr. Dodaro is scheduled to share the GAO’s extensive efforts aimed at curbing improper payments and bolstering the long-term sustainability of the Medicare system. This session offers a pivotal opportunity for Commissioners to engage in dialogue regarding strategies to enhance the overall value of Medicare expenditures for both taxpayers and beneficiaries.
Commitment to Public Transparency
MedPAC operates with a steadfast dedication to transparency, ensuring public access to its deliberations and findings. This commitment is evidenced by several initiatives: public meetings are webcast live, transcripts and presentations are promptly published following these sessions, and all reports, comment letters, and congressional testimony, alongside submissions from interested parties, are made available online. In line with this philosophy, the Commission has proactively disclosed key policy issues slated for examination throughout the current meeting cycle. It is important to note that this agenda may be adjusted based on the availability of data, progress in analytical work, the Commission's ongoing discussions, and any evolving circumstances.
Statutory Reporting Obligations to Congress
By legal mandate, MedPAC is required to submit two reports to the United States Congress annually. The first report is due by March 15th and meticulously assesses the adequacy of Medicare’s payment structures. It culminates in recommendations to Congress concerning potential updates and adjustments to these payments. The second report, due by June 15th, delves into broader issues impacting the Medicare program. This latter report also has the scope to include recommendations for refining Medicare’s payment systems, with a dual objective of fostering beneficiary access to necessary care and promoting the efficient utilization of program resources. Beyond these mandated reports, MedPAC consistently publishes periodic data books that furnish valuable information regarding the Medicare program, its beneficiaries, and the participating providers and plans. The Commission also drafts comment letters in response to proposed rules issued by the Centers for Medicare & Medicaid Services (CMS) and produces its yearly Payment Basics series, which clarifies the operational intricacies of various Medicare payment systems.
Examining Fee-for-Service Payment Adequacy
In the upcoming months, the Commission is set to undertake a thorough analysis of the sufficiency of Medicare’s fee-for-service (FFS) payments across a broad spectrum of healthcare settings. This includes detailed reviews for hospitals, clinicians, outpatient dialysis facilities, skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and hospice agencies. Concurrently, the Commission will also furnish updated status reports concerning the Medicare Advantage (MA) and Part D programs, as well as ambulatory surgical centers. These analytical endeavors will encompass crucial data points related to Medicare payments, the accessibility of care for beneficiaries, and, where feasible, an evaluation of the quality of care delivered to enrollees.
Deep Dive into Medicare Advantage Dynamics
MedPAC will extend its ongoing efforts in evaluating the Medicare Advantage program. Given the substantial growth of the MA program over the last decade, understanding the enrollee experience and its financial implications for the federal budget has become increasingly vital. The Commission’s continued investigation will scrutinize MA plan provider networks and their impact on access to care, the circumstances of institutionalized beneficiaries enrolled in MA, and the complexities of risk adjustment, specifically acknowledging the role of encounter data. Furthermore, plans are in place to analyze the mechanisms by which MA plans reimburse providers for services and to assess the financial impact that MA has on these providers.
Comprehensive Review of the Part D Program
The annual review of the Medicare prescription drug program (Part D) is also on MedPAC’s agenda. This review will encompass an examination of program spending, enrollment patterns, available benefit offerings, and beneficiary cost-sharing responsibilities. The Commission intends to maintain its oversight of the availability of benchmark plans for low-income subsidy (LIS) beneficiaries. Additionally, it plans to analyze drug pricing data submitted by Part D plans and evaluate plan bids to discern the effects of the Inflation Reduction Act (IRA) and other policy adjustments on the stability of the Part D plan (PDP) market.
Additional Analytic Initiatives and Mandated Reports
Beyond these core areas, MedPAC is engaged in several other important projects within the Medicare program. This includes efforts to articulate the complex array of choices confronting Medicare beneficiaries and to assess the information and assistance available to them in making these critical decisions. The Commission also plans to explore a supplementary methodology for quantifying changes in the volume of services rendered under the physician fee schedule.
Significant work is also underway to fulfill specific reporting requirements mandated by federal legislation. MedPAC will finalize three additional reports stemming from the Bipartisan Budget Act of 2018: an analysis of recent changes to the home health prospective payment system, particularly the impact of the new 30-day unit of payment, due in March 2026; an updated analysis on the performance of MA dual-eligible special needs plans, also due in March 2026; and a continued analysis of newly reported data for ambulance services, alongside a recommendation on the continuation of such data collection, due in June 2026. Furthermore, the Commission will continue its work on two annually required reports: one on Medicaid utilization and spending and non–FFS Medicare margins in nursing homes, as stipulated by the Affordable Care Act of 2010; and another report focusing on payments to rural emergency hospitals, mandated by the Consolidated Appropriations Act, 2021.
Core Principles Guiding MedPAC's Work
The Commission’s agenda is shaped by a confluence of statutory obligations, congressional interests, and the specific concerns of the Commission itself, all directed by MedPAC’s Chair and Executive Director. Three foundational principles consistently guide MedPAC’s work: first, payment rates must be adequate to ensure beneficiaries can access high-quality healthcare in appropriate clinical environments; second, Medicare payments should promote efficient care delivery, thereby preventing an undue fiscal burden on beneficiaries and taxpayers; and third, providers should be incentivized to deliver appropriate and equitable care in a cost-effective manner. In all its undertakings, MedPAC employs a deliberate, analytical framework to furnish Congress with well-reasoned, empirically-supported information and recommendations concerning Medicare.
Latest Updates on this Story
The regulatory landscape surrounding Medicare is constantly evolving, with breaking news emerging regularly. Recent developments often highlight the critical need for comprehensive analysis like that undertaken by MedPAC. We provide the latest updates and current news on how these policy discussions will shape the future of healthcare for seniors and people with disabilities. You can monitor all live updates on this story in real-time on MedicareTicker.com.
Related Topics
🔹 Medicare Policy Analysis 🔹 MedPAC Congressional Reports 🔹 Medicare Advantage Oversight 🔹 Part D Prescription Drug Program 🔹 Healthcare Spending Efficiency 🔹 Beneficiary Access to Care 🔹 Federal Healthcare Budget 🔹 US Government Accountability Office
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Frequently Asked Questions
What is the primary focus of MedPAC's upcoming 2025-2026 meeting cycle?
The Commission's agenda centers on a thorough examination of Medicare's payment systems, the expansion of Medicare Advantage, and the dynamics of the Part D prescription drug program. It also aims to assess the program's sustainability and efficiency for both beneficiaries and taxpayers.
Who is Gene Dodaro, and what will be his role at the September meeting?
Gene Dodaro is the Comptroller General of the United States and leads the U.S. Government Accountability Office (GAO). He is slated to present the GAO's findings and efforts concerning the reduction of improper payments within Medicare and strategies for enhancing the program's long-term viability.
How does MedPAC ensure transparency in its operations?
MedPAC maintains transparency by webcasting all its public meetings, promptly publishing meeting transcripts and presentations, and making all reports, comment letters, and congressional testimonies publicly available online. It also publishes submissions from interested parties in response to meeting discussions.
What specific aspects of Medicare Advantage will MedPAC be investigating?
MedPAC plans an in-depth assessment of the Medicare Advantage program, focusing on its significant growth, the experiences of enrollees, and its fiscal impact on the federal budget. This includes scrutinizing provider networks, access to care, institutionalized beneficiaries, risk adjustment mechanisms, and how MA plans compensate providers.