42 U.S.C. § 1395b-6 : US Code - Section 1395B-6: Medicare Payment Advisory Commission

Search 42 U.S.C. § 1395b-6 : US Code - Section 1395B-6: Medicare Payment Advisory Commission

(a) Establishment
There is hereby established the Medicare Payment Advisory
Commission (in this section referred to as the "Commission").
(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 1 of each year (beginning with
1998), 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.
(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 of this subchapter,
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+Choice 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 of this subchapter, 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
Specifically, the Commission shall review the effect of
payment policies under this subchapter on the delivery of
health care services other than under this subchapter and
assess the implications of changes in health care delivery in
the United States and in the general market for health care
services on the medicare program.
(3) Comments on certain secretarial reports
If the Secretary submits to Congress (or a committee of
Congress) a report that is required by law and that relates to
payment policies under this subchapter, the Secretary shall
transmit a copy of the report to the Commission. The Commission
shall review the report and, not later than 6 months after the
date of submittal of the Secretary's report to Congress, shall
submit to the appropriate committees of Congress written comments
on such report. Such comments may include such recommendations as
the Commission deems appropriate.
(4) Agenda and additional reviews
The Commission shall consult periodically with the chairmen and
ranking minority members of the appropriate committees of
Congress regarding the Commission's agenda and progress towards
achieving the agenda. The Commission may conduct additional
reviews, and submit additional reports to the appropriate
committees of Congress, from time to time on such topics relating
to the program under this subchapter as may be requested by such
chairmen and members and as the Commission deems appropriate.
(5) Availability of reports
The Commission shall transmit to the Secretary a copy of each
report submitted under this subsection and shall make such
reports available to the public.
(6) Appropriate committees of Congress
For purposes of this section, the term "appropriate committees
of Congress" means the Committees on Ways and Means and Commerce
of the House of Representatives and the Committee on Finance of
the Senate.
(7) Voting and reporting requirements
With respect to each recommendation contained in a report
submitted under paragraph (1), each member of the Commission
shall vote on the recommendation, and the Commission shall
include, by member, the results of that vote in the report
containing the recommendation.
(8) Examination of budget consequences
Before making any recommendations, the Commission shall examine
the budget consequences of such recommendations, directly or
through consultation with appropriate expert entities.
(c) Membership
(1) Number and appointment
The Commission shall be composed of 17 members appointed by the
Comptroller General.
(2) Qualifications
(A) In general
The membership of the Commission shall include individuals
with national recognition for their expertise in health finance
and economics, actuarial science, health facility management,
health plans and integrated delivery systems, reimbursement of
health facilities, allopathic and osteopathic physicians, and
other providers of health services, and other related fields,
who provide a mix of different professionals, broad geographic
representation, and a balance between urban and rural
representatives.
(B) Inclusion
The membership of the Commission shall include (but not be
limited to) physicians and other health professionals, experts
in the area of pharmaco-economics or prescription drug benefit
programs, employers, third-party payers, individuals skilled in
the conduct and interpretation of biomedical, health services,
and health economics research and expertise in outcomes and
effectiveness research and technology assessment. Such
membership shall also include representatives of consumers and
the elderly.
(C) Majority nonproviders
Individuals who are directly involved in the provision, or
management of the delivery, of items and services covered under
this subchapter shall not constitute a majority of the
membership of the Commission.
(D) Ethical disclosure
The Comptroller General shall establish a system for public
disclosure by members of the Commission of financial and other
potential conflicts of interest relating to such members.
Members of the Commission shall be treated as employees of
Congress for purposes of applying title I of the Ethics in
Government Act of 1978 (Public Law 95-521).
(3) Terms
(A) In general
The terms of members of the Commission shall be for 3 years
except that the Comptroller General shall designate staggered
terms for the members first appointed.
(B) Vacancies
Any member appointed to fill a vacancy occurring before the
expiration of the term for which the member's predecessor was
appointed shall be appointed only for the remainder of that
term. A member may serve after the expiration of that member's
term until a successor has taken office. A vacancy in the
Commission shall be filled in the manner in which the original
appointment was made.
(4) Compensation
While serving on the business of the Commission (including
traveltime), a member of the Commission shall be entitled to
compensation at the per diem equivalent of the rate provided for
level IV of the Executive Schedule under section 5315 of title 5;
and while so serving away from home and the member's regular
place of business, a member may be allowed travel expenses, as
authorized by the Chairman of the Commission. Physicians serving
as personnel of the Commission may be provided a physician
comparability allowance by the Commission in the same manner as
Government physicians may be provided such an allowance by an
agency under section 5948 of title 5, and for such purpose
subsection (i) of such section shall apply to the Commission in
the same manner as it applies to the Tennessee Valley Authority.
For purposes of pay (other than pay of members of the Commission)
and employment benefits, rights, and privileges, all personnel of
the Commission shall be treated as if they were employees of the
United States Senate.
(5) Chairman; Vice Chairman
The Comptroller General shall designate a member of the
Commission, at the time of appointment of the member as Chairman
and a member as Vice Chairman for that term of appointment,
except that in the case of vacancy of the Chairmanship or Vice
Chairmanship, the Comptroller General may designate another
member for the remainder of that member's term.
(6) Meetings
The Commission shall meet at the call of the Chairman.
(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 5 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
The Commission may secure directly from any department or
agency of the United States information necessary to enable it to
carry out this section. Upon request of the Chairman, the head of
that department or agency shall furnish that information to the
Commission on an agreed upon schedule.
(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
The Comptroller General shall have unrestricted access to all
deliberations, records, and nonproprietary data of the
Commission, immediately upon request.
(4) Periodic audit
The Commission shall be subject to periodic audit by the
Comptroller General.
(f) Authorization of appropriations
(1) Request for appropriations
The Commission shall submit requests for appropriations in the
same manner as the Comptroller General submits requests for
appropriations, but amounts appropriated for the Commission shall
be separate from amounts appropriated for the Comptroller
General.
(2) Authorization
There are authorized to be appropriated such sums as may be
necessary to carry out the provisions of this section. Sixty
percent of such appropriation shall be payable from the Federal
Hospital Insurance Trust Fund, and 40 percent of such
appropriation shall be payable from the Federal Supplementary
Medical Insurance Trust Fund.