The Medicare Payment Advisory Commission this week discussed several draft recommendations for Congress, which the panel could vote on in January. The proposals would increase payment rates for hospital inpatient and outpatient services by 2.0 percent in 2020, with an additional 0.8 percent increase to be allotted via MedPAC's proposed hospital value incentive program; provide no payment update for skilled nursing facilities in 2020; and reduce payment rates for inpatient rehabilitation facilities and home health agencies by 5 percent in 2020. The commission also expressed support for the in-process redesign of the SNF prospective payment system in 2020, including annually recalibrating its relative weights. The commission failed to reach consensus on a draft recommendation by the chairman to eliminate the market-basket update for the long-term care hospital PPS in 2020 and agreed to continue discussing the recommendation in January. The commission also could vote on recommendations to eliminate “incident to” billing for advanced practice registered nurses and physician assistants and require them to bill Medicare directly, and refine specialty designations for these advanced practice clinicians; increase 2020 payment rates for physicians and other health professional services by the amount specified in current law; eliminate the ambulatory surgical center conversion factor update for 2020; and require ASCs to report cost data.

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