Margot Sanger-Katz, about the IPAB, in a gated National Journal piece from October:
So far, the board has done nothing at all. Although it received a $15 million budget in the last fiscal year, Obama has failed to nominate a single member to the body. To form the board, its 15 full-time members will need to be confirmed by the Senate, a daunting prospect given GOP opposition to IPAB. But post-election nominations are almost certainly in the works if Obama wins, and senators would be wise to let some of the nominations go through. If the board fails to make recommendations when required, its power is transferred to the secretary of Health and Human Services. Instead of 15 “unelected bureaucrats” calling the shots on Medicare policy, the country will be left with just one.
See Section (C)(5) here. One interpretation is that if the Senate fails to confirm IPAB members, the power the board would otherwise have transfers to the Secretary. It’s hard to imagine this interpretation is not legally contested. If it holds up, it’s hard to imagine the Secretary not facing intense scrutiny by congressional committees with relevant oversight.