View all text of Subchapter XVIII [§ 1395 - § 1395lll]
§ 1395b–6. Medicare Payment Advisory Commission
(a) Establishment
(b) Duties
(1) Review of payment policies and annual reports
The Commission shall—
(A) review payment policies under this subchapter, including the topics described in paragraph (2);
(B) make recommendations to Congress concerning such payment policies;
(C) by not later than March 15,1
1 So in original.
submit a report to Congress containing the results of such reviews and its recommendations concerning such policies; and(D) by not later than June 15 of each year, submit a report to Congress containing an examination of issues affecting the medicare program, including the implications of changes in health care delivery in the United States and in the market for health care services on the medicare program and including a review of the estimate of the conversion factor submitted under section 1395w–4(d)(1)(E)(ii) of this title, and (beginning with 2012) containing an examination of the topics described in paragraph (9), to the extent feasible.
(2) Specific topics to be reviewed
(A) Medicare+Choice program
Specifically, the Commission shall review, with respect to the Medicare+Choice program under part C, the following:
(i) The methodology for making payment to plans under such program, including the making of differential payments and the distribution of differential updates among different payment areas.
(ii) The mechanisms used to adjust payments for risk and the need to adjust such mechanisms to take into account health status of beneficiaries.
(iii) The implications of risk selection both among Medicare+Choice organizations and between the Medicare+Choice option and the original medicare fee-for-service option.
(iv) The development and implementation of mechanisms to assure the quality of care for those enrolled with Medicare+ÐChoice organizations.
(v) The impact of the Medicare+Choice program on access to care for medicare beneficiaries.
(vi) Other major issues in implementation and further development of the Medicare+Choice program.
(B) Original medicare fee-for-service system
Specifically, the Commission shall review payment policies under parts A and B, including—
(i) the factors affecting expenditures for the efficient provision of services in different sectors, including the process for updating hospital, skilled nursing facility, physician, and other fees,
(ii) payment methodologies, and
(iii) their relationship to access and quality of care for medicare beneficiaries.
(C) Interaction of medicare payment policies with health care delivery generally
(3) Comments on certain secretarial reports
(4) Agenda and additional reviews
(5) Availability of reports
(6) Appropriate committees of Congress
(7) Voting and reporting requirements
(8) Examination of budget consequences
(9) Review and annual report on Medicaid and commercial trends
(10) Coordinate and consult with the Federal Coordinated Health Care Office
(11) Interaction of Medicaid and Medicare
(c) Membership
(1) Number and appointment
(2) Qualifications
(A) In general
(B) Inclusion
(C) Majority nonproviders
(D) Ethical disclosure
(3) Terms
(A) In general
(B) Vacancies
(4) Compensation
(5) Chairman; Vice Chairman
(6) Meetings
(d) Director and staff; experts and consultants
Subject to such review as the Comptroller General deems necessary to assure the efficient administration of the Commission, the Commission may—
(1) employ and fix the compensation of an Executive Director (subject to the approval of the Comptroller General) and such other personnel as may be necessary to carry out its duties (without regard to the provisions of title 5 governing appointments in the competitive service);
(2) seek such assistance and support as may be required in the performance of its duties from appropriate Federal departments and agencies;
(3) enter into contracts or make other arrangements, as may be necessary for the conduct of the work of the Commission (without regard to section 6101 of title 41);
(4) make advance, progress, and other payments which relate to the work of the Commission;
(5) provide transportation and subsistence for persons serving without compensation; and
(6) prescribe such rules and regulations as it deems necessary with respect to the internal organization and operation of the Commission.
(e) Powers
(1) Obtaining official data
(2) Data collection
In order to carry out its functions, the Commission shall—
(A) utilize existing information, both published and unpublished, where possible, collected and assessed either by its own staff or under other arrangements made in accordance with this section,
(B) carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate, and
(C) adopt procedures allowing any interested party to submit information for the Commission’s use in making reports and recommendations.
(3) Access of GAO to information
(4) Periodic audit
(f) Authorization of appropriations
(1) Request for appropriations
(2) Authorization
(Aug. 14, 1935, ch. 531, title XVIII, § 1805, as added Pub. L. 105–33, title IV, § 4022(a), Aug. 5, 1997, 111 Stat. 350; amended Pub. L. 105–277, div. J, title V, § 5202(a), Oct. 21, 1998, 112 Stat. 2681–917; Pub. L. 106–113, div. B, § 1000(a)(6) [title II, § 211(a)(2)(B)], Nov. 29, 1999, 113 Stat. 1536, 1501A–347; Pub. L. 106–554, § 1(a)(6) [title V, § 544(a)(1), (b)], Dec. 21, 2000, 114 Stat. 2763, 2763A–551; Pub. L. 108–173, title VII, § 735(a)–(c)(1), (e)(1), Dec. 8, 2003, 117 Stat. 2353, 2354; Pub. L. 110–173, title III, § 301, Dec. 29, 2007, 121 Stat. 2514; Pub. L. 111–148, title II, § 2801(b), title III, § 3403(c), Mar. 23, 2010, 124 Stat. 332, 507; Pub. L. 115–123, div. E, title XI, § 52001(b)(3), Feb. 9, 2018, 132 Stat. 298; Pub. L. 117–286, § 4(c)(41), Dec. 27, 2022, 136 Stat. 4359.)