[House Report 105-774]
[From the U.S. Government Publishing Office]
105th Congress Rept. 105-774
HOUSE OF REPRESENTATIVES
2d Session Part 1
_______________________________________________________________________
EXPANSION OF MEMBERSHIP OF THE MEDICARE PAYMENT ADVISORY COMMISSION TO
17
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October 5, 1998.--Ordered to be printed
_______________________________________________________________________
Mr. Archer, from the Committee on Ways and Means, submitted the
following
R E P O R T
[To accompany H.R. 4377]
[Including cost estimate of the Congressional Budget Office]
The Committee on Ways and Means, to whom was referred the
bill (H.R. 4377) to amend title XVIII of the Social Security
Act to expand the membership of the Medicare Payment Advisory
Commission to 17, having considered the same, report favorably
thereon without amendment and recommend that the bill do pass.
CONTENTS
Page
I. Introduction......................................................2
A. Purpose and Summary................................... 2
B. Background and Need for Legislation................... 2
C. Legislative History................................... 2
II. Explanation of Provisions.........................................2
III.Vote of the Committee.............................................3
IV. Budget Effects of the Bill........................................3
A. Committee Estimate of Budgetary Effects............... 3
B. Statement Regarding New Budget Authority and Tax
Expenditures......................................... 3
C. Cost Estimate Prepared by the Congressional Budget
Office............................................... 4
V. Other Matters to be Discussed under the Rules of the House........4
A. Committee Oversight Findings and Recommendations...... 4
B. Summary of Findings and Recommendations of the
Government Operations Committee...................... 5
C. Constitutional Authority Statement.................... 5
VI. Changes in Existing Law Made by the Bill as Reported..............5
I. INTRODUCTION
A. Purpose and Summary
H.R. 4377 expands the number of Commissioners serving on
the Medicare Payment Advisory Commission (MedPAC).
B. Background and Need for the Legislation
The Balanced Budget Act of 1997, Public Law 105-33,
established the Medicare Payment Advisory Commission (MedPAC)
as a result of merging two commissions, the Prospective Payment
Advisory Commission and the Physician Payment Review
Commission. MedPAC, like its predecessors, is a nonpartisan
commission which advises Congress and makes recommendations
regarding Medicare payment policies.
Section 4022 of the Balanced Budget Act detailed the
criteria for membership on the Commission: 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.
MedPAC commissioners are appointed by the Comptroller
General and serve terms of three years. The Balanced Budget Act
authorizes the Commission to have fifteen commissioners. H.R.
4377 would increase the number of commissioners appointed to
MedPAC to seventeen.
The addition of two commissioners would enable the
commission to reflect more fully the diversity of backgrounds
and interests in the health policy community. Expanding the
number of commissioners would not only allow for a greater
range of professional expertise but also a more diverse
representation from various parts of the country.
C. Legislative History
On Tuesday, September 15, 1998, the Subcommittee on Health
ordered favorably reported to the full Committee, by voice
vote, H.R. 4377, without amendment. On Friday, September 18,
1998, the Committee on Ways and Means ordered favorably
reported, H.R. 4377, without amendment.
II. EXPLANATION OF PROVISION
1. Expansion of Membership of the Medicare Payment Advisory Commission
Current law
Section 4022 of the Balanced Budget Act established the
Medicare Payment Advisory Commission (MedPAC) as a result of
merging two commissions, the Prospective Payment Assessment
Commission and the Physician Payment Review Commission. MedPAC,
like its predecessors, is a nonpartisan commission which
advises Congress and makes recommendations regarding Medicare
payment policies. The Commission reports to the Committee on
Ways and Means, the House Commerce Committee and the Senate
Finance Committee. MedPAC commissioners are appointed by the
Comptroller General and serve terms of three years. The
Balanced Budget Act authorizes the Commission to have fifteen
commissioners.
Explanation of provision
H.R. 4377 increases the number of commissioners appointed
to MedPAC to seventeen from the current fifteen.
Reason for change
The addition of two commissioners would enable the
commission to reflect more fully the diversity of backgrounds
and interests in the health policy community. Expanding the
number of commissioners would not only allow for a greater
range of professional expertise but also a more diverse
representation from various parts of the country.
Effective date
May 1, 1999.
III. VOTE OF THE COMMITTEE
In compliance with clause 2(l)(2)(B) of rule XI of the
Rules of the House of Representatives, the following statements
are made concerning the votes of the Committee in its
consideration of the bill:
motion to report the bill
The bill, H.R. 4377, was ordered favorably reported by
voice vote on September 18, 1998, with a quorum being present.
IV. BUDGET EFFECTS OF THE BILL
A. Committee Estimate of Budgetary Effects
In compliance with clause 7(a) of rule XIII of the Rules of
the House of Representatives, the following statement is made:
The Committee agrees with the estimate prepared by the
Congressional Budget Office (CBO) which is included below.
B. Statement Regarding New Budget Authority and Tax Expenditures
In compliance with clause 2(l)(3)(B) of rule XI of the
Rules of the House of Representatives, the Committee states
that the provisions in the Committee bill, if enacted, would
have no impact on direct spending.
C. Cost Estimate Prepared by the Congressional Budget Office
U.S. Congress,
Congressional Budget Office,
Washington, DC, September 23, 1998.
Hon. Bill Archer,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 4377, a bill to
amend title XVIII of the Social Security Act to expand the
membership of the Medicare Payment Advisory Commission to 17.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Tom Bradley.
Sincerely,
June E. O'Neill, Director.
Enclosure.
H.R. 4377--A bill to amend title XVIII of the Social Security Act to
expand the membership of the Medicare Payment Advisory
Commission to 17
CBO estimates that enacting this bill would increase
spending by $15,000 in 1999 and by about $30,000 annually in
subsequent years, assuming appropriation of the necessary
amounts. Because the bill would not affect direct spending or
receipts, pay-as-you-go procedures would not apply. H.R. 4377
contains no intergovernmental or private-sector mandates as
defined in the Unfunded Mandates Reform Act and would no affect
the budgets of state, local, or tribal governments.
H.R. 4377 would expand the membership of the Medicare
Payment Advisory Commission (MedPAC) by two, from 15 to 17. The
terms of the new members would begin on May 1, 1999. MedPAC
expects spending for members' compensation and travel to
average less than $15,000 per commissioner in 1998 and 1999.
Therefore, the bill would increase MedPAC spending by $15,000
(half the annual cost of two commissioners) in 1999, and by
$30,000 in subsequent years.
The CBO staff contact for this estimate is Tom Bradley.
This estimate was approved by Paul N. Van de Water, Assistant
Director for Budget Analysis.
V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE
A. Committee Oversight Findings and Recommendations
With respect to clause 2(l)(3)(A) of rule XI of the Rules
of the House of Representatives, the Committee states that the
Subcommittee on Health believes that the action taken was
necessary due to it's oversight of the Medicare Payment
Advisory Commission (MedPAC).
B. Summary of Findings and Recommendations of the Government Operations
Committee
With respect to clause 2(l)(3)(D) of rule XI of the Rules
of the House of Representatives, the Committee states that no
oversight findings or recommendations have been submitted by
the Committee on Government Reform and Oversight regarding the
subject of the bill.
C. Constitutional Authority Statement
With respect to clause 2(l)(4) of rule XI of the Rules of
the House of Representatives, relating to Constitutional
Authority, the Committee states that the Committee's action in
reporting the bill is derived from Article I of the
Constitution, Section 8 (``The Congress shall have power to lay
and collect taxes, duties, imposts and excises, to pay the
debts and provide for the common defense and general welfare of
the United States. * * *'').
VI. CHANGES IN EXISTING LAW MADE BY THE BILL AS REPORTED
In compliance with the Rules of the House of
Representatives, changes in existing law made by the bill, as
reported, are shown as follows (existing law proposed to be
omitted is enclosed in black brackets, new matter is printed in
italic, existing law in which no change is proposed is shown in
roman):
SECTION 1805 OF THE SOCIAL SECURITY ACT
medicare payment advisory commission
Sec. 1805. (a) * * *
* * * * * * *
(c) Membership.--
(1) Number and appointment.--The Commission shall be
composed of [15] 17 members appointed by the
Comptroller General.
* * * * * * *