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How the board might workIf the IPAB authority is not repealed, the president will appoint members after consulting with Congress. The positions carry a six-year term and a $165,000 annual salary and are subject to Senate approval.Board members are expected to be experts in health care finance and economics, actuarial science, management, health insurance, integrated delivery systems and payment models, according to a March Congressional Research Service report. In addition, members should have expertise in certain sectors of the health care system, meaning that a doctor, an expert on drug manufacturing, an employer representative, a third-party payer official or a patient advocate could be a nominee. However, the statute states that a majority of members should not be involved directly in providing Medicare services, limiting the participation of practicing Medicare physicians.The Centers for Medicare & Medicaid Services chief actuary first would decide in 2013 if IPAB actions are needed. The actuary will calculate a Medicare per-capita growth rate and a target rate defined by statute. Starting in 2018, growth targets will be pegged to gross domestic product plus one percentage point.IPAB would not be required to act as long as program growth remains under that target rate. If it exceeds the target, the board would be required to submit a cost-savings proposal that Congress must consider under special fast-track rules. The proposal would become law unless Congress passes an alternative with the same level of savings or overrides the proposal with a three-fifths vote in the Senate.Those spending reductions could go into effect as early as 2015, but government actuaries said that is unlikely. The Congressional Budget Office projects that Medicare spending will not eclipse growth targets for years, and thus IPAB wonâ€™t be responsible for drafting a savings plan through at least 2021 if expected trends hold.In the event that IPAB action is required, the board cannot recommend rationing health care services, raising patient premiums or fees, restricting benefits or altering eligibility. That means the boardâ€™s options are reducing fee-for-service pay rates, cutting subsidies to Medicare private insurers and drug plans, and implementing health delivery reforms. Furthermore, the law bans IPAB cuts to hospital pay until 2020, so physicians and other health professionals are the only ones exposed to potential pay cuts in the initial years.
Furthermore, the law bans IPAB cuts to hospital pay until 2020, so physicians and other health professionals are the only ones exposed to potential pay cuts in the initial years.
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