Independent Payment Advisory Board The Independent Payment Advisory Board, or IPAB, is a fifteen-member United States Government agency created in by sections and of the Patient Protection and Affordable Care Act which has the explicit task of achieving specified savings in Medicare without affecting coverage or quality. 1 Under previous and current law, changes to Medicare payment rates and program rules are recommended by MedPAC but require an act of Congress to take effect. The new system grants IPAB the authority to make changes to the Medicare program with the Congress being given the power to overrule the agency's decisions through supermajority vote. Beginning in , the Chief Actuary of the Centers for Medicare and Medicaid Services determine in particular years the projected per capita growth rate for Medicare for a multi-year period ending in the second year thereafter (the "implementation year"). If the projection exceeds a target growth rate, IPAB must develop a proposal to reduce Medicare spending in the implementation year by a specified amount. If it is required to develop a proposal, the Board must submit that proposal in of the year before the implementation year; thus, the first proposal could be submitted in to take effect in. If the Board fails to submit a proposal that the Chief Actuary certifies achieve the savings target, the Secretary of Health and Human Services must submit a proposal that achieve that amount of savings. The Secretary must then implement the proposal unless Congress enacts resolutions made to override the Board's (or the Secretary's) decisions under a fast-track procedure that the law sets forth.
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