The Medicare Access and CHIP Reauthorization Act (MACRA)

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) makes sweeping changes to how Medicare pays for physician services. MACRA repealed the Medicare sustainable growth rate formula, and instead, provided predictable payment increased. Implementation establishes new physician and value-based payment programs.

Eligible clinicians will be required to participate in one of two tracks: the default Merit-based Incentive Payment System (MIPS), or the alternative payment model (APM). The final rule tempered some of the parameters of concern to OAHHS, our members, and other providers.

Merit-Based Incentive Payment System (MIPS)

Starting in 2019, the MIPS will be the default payment system which ties performance measures to payments, either bonuses or penalties. CMS originally proposed clinicians being required to submit a full year of data for all four performance categories in order to be eligible for a potential bonus of up to 4 percent. CMS is now only requiring clinicians to report data from any 90-day continuous period on only the cost and resource performance measures during CY 2017. 

Advanced Alternative Payment Model (APM)

Providers who receive a substantial portion of their reimbursement from Advanced APMs are exempt from MIPS. MACRA provides incentives for clinicians who participate in advanced APMs. 

For an Advanced APM requirement, participating providers must bear more than nominal risk under the reimbursement model. In the final rule, CMS sets this standard for 2017 and 2018 as a potential downside of 8 percent of all Medicare reimbursements or 3 percent (down from 4 percent in the proposed rule) of the expected expenditures for which the provider is responsible under the APM itself.

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