MedPAC Recommends FFS Benefit Changes

For care coordination in FFS Medicare, the commission's recommendations include:

• Create a per-beneficiary payment for care coordination
• Add or modify codes to allow providers to bill for selected care coordination activities
• Develop payment policies to reward coordinated care and penalize fragmented care.

In its report, the commission cites poor care coordination as contributing to repeated medical tests, poor transitions between care sites, and the "unnecessary use of high intensity settings." Its recommendations are the beginning of an effort to improve care coordination by making it an "integral part of the system providing the care."

The commission's recommendations for care coordination for dual-eligibles include:

• Improve the Medicare Advantage (MA) risk adjustment to more accurately predict risk across all MA enrollees.
• Pay providers for the Program of All-Inclusive Care for the Elderly (PACE) based on the MA payment system for setting benchmarks and quality bonuses.
• Change PACE eligibility criteria to allow nursing home-certifiable Medicare beneficiaries under age of 55 to enroll.
• Provide prorated Medicare capitation payments to PACE providers for partial-month enrollees.
• Establish outlier payment caps
• Publish select quality measures on PACE providers and develop appropriate quality measures to enable PACE providers to participate in the Medicare Advantage quality bonus program by 2015.

The commissioners would like make the PACE program, which is a provider-based integrated care program structured around day care centers, accessible to more beneficiaries. Improving the MA risk adjustment system to more accurately predict risk across all MA enrollees would help make payments for PACE reflect the costs of the PACE program.