▁was ▁to ▁have ▁the ▁explicit ▁task ▁of ▁ach ieving ▁specified ▁sav ings ▁in ▁Medic are ▁without ▁affect ing ▁coverage ▁or ▁quality . ▁Under ▁previous ▁and ▁current ▁law , ▁changes ▁to ▁Medic are ▁payment ▁rates ▁and ▁program ▁rules ▁are ▁recommended ▁by ▁Med P AC ▁but ▁require ▁an ▁act ▁of ▁Congress ▁to ▁take ▁effect . ▁ ▁The ▁system ▁creating ▁IP AB ▁granted ▁IP AB ▁the ▁authority ▁to ▁make ▁changes ▁to ▁the ▁Medic are ▁program ▁with ▁the ▁Congress ▁being ▁given ▁the ▁power ▁to ▁over rule ▁the ▁ag ency ' s ▁dec isions ▁through ▁super major ity ▁vote . ▁ ▁The ▁B ipart isan ▁Bud get ▁Act ▁of ▁ 2 0 1 8 ▁repe aled ▁IP AB ▁before ▁it ▁could ▁take ▁effect . ▁ ▁Begin ning ▁in ▁ 2 0 1 3 , ▁the ▁Chief ▁Act u ary ▁of ▁the ▁Cent ers ▁for ▁Medic are ▁and ▁Med ica id ▁Services ▁determined ▁in ▁particular ▁years ▁the ▁project ed ▁per ▁cap ita ▁growth ▁rate ▁for ▁Medic are ▁for ▁a ▁multi - year ▁period ▁ending ▁in ▁the ▁second ▁year ▁there after ▁( the ▁" implementation ▁year "). ▁If ▁the ▁projection ▁exceed ed ▁a ▁target ▁growth ▁rate , ▁IP AB ▁was ▁to ▁develop ▁a ▁proposal ▁to ▁reduce ▁Medic are ▁sp ending ▁in ▁the ▁implementation ▁year ▁by ▁a ▁specified ▁amount . ▁If ▁it ▁was ▁required ▁to ▁develop ▁a ▁proposal , ▁the ▁Board ▁was ▁to ▁submit ▁that ▁proposal ▁in ▁January ▁of ▁the ▁year ▁before ▁the ▁implementation ▁year ; ▁thus , ▁the ▁first ▁proposal ▁could ▁have ▁been ▁submitted ▁in ▁January ▁ 2 0 1