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United States Code (Last Updated: May 24, 2014) |
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Title 42. THE PUBLIC HEALTH AND WELFARE |
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Chapter 7. SOCIAL SECURITY |
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SubChapter XVIII. HEALTH INSURANCE FOR AGED AND DISABLED |
§ 1395b–6. Medicare Payment Advisory Commission
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(a) Establishment There is hereby established as an agency of Congress 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 15, of the Patient Protection and Affordable Care Act before making any recommendations regarding dual eligible individuals. (11) Interaction of Medicaid and Medicare The Commission shall consult with MACPAC in carrying out its duties under this section, as appropriate. Responsibility for analysis of and recommendations to change Medicare policy regarding Medicare beneficiaries, including Medicare beneficiaries who are dually eligible for Medicare and Medicaid, shall rest with the Commission. Responsibility for analysis of and recommendations to change Medicaid policy regarding Medicaid beneficiaries, including Medicaid beneficiaries who are dually eligible for Medicare and Medicaid, shall rest with MACPAC.
(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 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 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.
References In Text
The Patient Protection and Affordable Care Act, referred to in subsec. (b)(10), is Pub. L. 111–148,
The Ethics in Government Act of 1978, referred to in subsec. (c)(2)(D), is Pub. L. 95–521,
Codification
In subsec. (d)(3), “section 6101 of title 41” substituted for “section 3709 of the Revised Statutes (41 U.S.C. 5)” on authority of Pub. L. 111–350, § 6(c),
Amendments
2010—Subsec. (b)(1)(C). Pub. L. 111–148, § 2801(b)(1), substituted “March 15” for “March 1 of each year (beginning with 1998)”.
Subsec. (b)(1)(D). Pub. L. 111–148, § 2801(b)(2), inserted “, and (beginning with 2012) containing an examination of the topics described in paragraph (9), to the extent feasible” before the period.
Subsec. (b)(4). Pub. L. 111–148, § 3403(c)(2), added par. (4). Former par. (4) redesignated (5).
Subsec. (b)(5) to (8). Pub. L. 111–148, § 3403(c)(1), redesignated pars. (4) to (7) as (5) to (8), respectively. Former par. (8) relating to examination of budget consequences redesignated (9).
Subsec. (b)(9). Pub. L. 111–148, § 3403(c)(1), redesignated par. (8) relating to examination of budget consequences as (9).
Pub. L. 111–148, § 2801(b)(3), added par. (9) relating to review and annual report on Medicaid and commercial trends.
Subsec. (b)(10), (11). Pub. L. 111–148, § 2801(b)(3), added pars. (10) and (11).
2007—Subsec. (a). Pub. L. 110–173 inserted “as an agency of Congress” after “established”.
2003—Subsec. (b)(2)(B)(i). Pub. L. 108–173, § 735(b), inserted “the efficient provision of” after “expenditures for”.
Subsec. (b)(8). Pub. L. 108–173, § 735(a), added par. (8).
Subsec. (c)(2)(B). Pub. L. 108–173, § 735(e)(1), inserted “experts in the area of pharmaco-economics or prescription drug benefit programs,” after “other health professionals,”.
Subsec. (c)(2)(D). Pub. L. 108–173, § 735(c)(1), inserted at end “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).”
2000—Subsec. (b)(1)(D). Pub. L. 106–554, § 1(a)(6) [title V, § 544(a)(1)], substituted “June 15 of each year,” for “June 1 of each year (beginning with 1998),”.
Subsec. (b)(7). Pub. L. 106–554, § 1(a)(6) [title V, § 544(b)], added par. (7).
1999—Subsec. (b)(1)(D). Pub. L. 106–113 inserted “and including a review of the estimate of the conversion factor submitted under section 1395w–4(d)(1)(E)(ii) of this title” before period at end.
1998—Subsec. (c)(1). Pub. L. 105–277 substituted “17” for “15”.
Change Of Name
References to Medicare+Choice deemed to refer to Medicare Advantage or MA, subject to an appropriate transition provided by the Secretary of Health and Human Services in the use of those terms, see section 201 of Pub. L. 108–173, set out as a note under section 1395w–21 of this title.
“Independent Payment Advisory Board” substituted for “Independent Medicare Advisory Board” in subsec. (b)(4) on authority of section 10320(b) of Pub. L. 111–148, set out as a note under section 1395kkk of this title.
Effective Date Of Amendment
Pub. L. 108–173, title VII, § 735(c)(2),
Pub. L. 106–554, § 1(a)(6) [title V, § 544(a)(2)],
Amendment by Pub. L. 106–113 effective in determining conversion factor under section 1395w–4(d) of this title for years beginning with 2001 and not applicable to or affecting any update (or any update adjustment factor) for any year before 2001, see section 1000(a)(6) [title II, § 211(d)] of Pub. L. 106–113, set out as a note under section 1395w–4 of this title.
Effective Date
Pub. L. 105–33, title IV, § 4022(c),
Miscellaneous
Pub. L. 108–173, title VII, § 735(e)(2),
Pub. L. 106–554, § 1(a)(6) [title II, § 214],
Pub. L. 106–113, div. B, § 1000(a)(6) [title II, § 229(c)],
Pub. L. 106–113, div. B, § 1000(a)(6) [title III, § 312(c)],
Pub. L. 106–113, div. B, § 1000(a)(6) [title IV, § 411],
Pub. L. 106–113, div. B, § 1000(a)(6) [title V, § 520(c)],
Pub. L. 105–277, div. J, title V, § 5202(b),
Pub. L. 105–33, title IV, § 4804(c),