Proposed Rule: Implementing provisions of MACRA – MIPS and APMs

Proposed Rule: Implementing provisions of MACRA – MIPS and APMs

On April 27, 2016 the Department of Health and Human Services (HHS) issued a proposed rule to implement key provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Included in the proposed rulemaking is the framework for the "Quality Payment Program," which includes two paths:

  • Merit-based Incentive Payment System (MIPS)
  • Alternative Payment Methods (APMs)

MIPS would consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and would continue the focus on quality, resource use, and use of certified EHR technology (CEHRT).

The proposed rule also would establish incentives for participation in certain alternative payment models (APMs) and includes proposed criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models.

Did you know?

  • The last performance period, for separate PQRS, VM and Medicare EHR Incentive Program reporting programs would be January 1, 2016 through December 31, 2016 for eligible MIPS providers.
  • The Center for Medicare & Medicaid Services (CMS) would begin measuring performance for doctors and other clinicians through MIPS in January 2017, with payments based on those measures beginning in 2019.
  • As directed by MACRA, through MIPS, the four performance categories are: Quality, Advancing Care Information ("advancing care information" is the new MIPS definition for meaningful use of certified EHR technology), Clinical Practice Improvement Activities (CPIAs), and Cost.
  • After calendar year 2018, there will no longer be a separate Medicare EHR Incentive Program (Meaningful Use) the PQRS, MU, and VM payment adjustment will sunset at the end of 2018.

Access the HHS announcement regarding the proposed rule by clicking HERE.

How we can help

MIPS and APMs is clearly where we are going next. While we understand the transition from Meaningful Use may feel confusing and stressful, we are taking steps to help organizations understand the process. We have put together an analysis or MIPS and APMs. Please contact us if you would like access to this analysis or if you have any questions regarding the transition to MIPS and APMs: [email protected] or 855-427-0427.