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MACRA Final Rule published October 14, 2016

October 24, 2016

MACRA Final Rule Published 10/14/2016

The Department of Health and Human Services (HHS) announced the release of the Medicare Access and CHIP Reauthorization Act (MACRA) Final Rule on October 14, 2016. Click here to view the 2,200 page Final Rule. The Final Rule finalizes the Quality Payment Program (QPP), which encompasses two tracks: Advanced Payment Model (APM) and Merit-Based Incentive Payment System (MIPS). Along with the Final Rule, HHS also launched a QPP resource page to help providers throughout the transition. Click here to access the resource page.

The Final Rule solidified who qualifies for the MACRA program. Physicians, PA’s, ARNP’s, and CRNA’s who bill Medicare more than $30,000 a year, or provide care to at least 100 Medicare patients, qualify for MACRA. CMS estimates that about 32.5% of providers will fall into this category and not be eligible for MACRA.
PHO is continuing to evaluate additional education opportunities to help providers throughout this transition, and will share information as it becomes available. Please see additional information below on the MIPS and APM tracks.

MIPS Track
The MIPS track is designed for providers currently in traditional, fee-for-service Medicare. MIPS encompasses Meaningful Use, the Physician Quality Reporting System, and the Value-Based Payment Modifier program. Providers will receive payment adjustments based on quality and value performance, similar to previous programs. The Final Rule allows providers to pick one of the following tracks for implementation in 2017:

  • Providers can do nothing. This will result in an automatic 4% negative payment adjustment in 2019.
  • Providers can submit minimal data, like only one of the quality measures, and receive no payment adjustment in 2019.
  • Providers can submit 90 days of data. This will result in a small positive payment adjustment or no payment adjustment in 2019.
  • Providers can submit a full year of data, which may result in a moderate positive payment adjustment in 2019.
  • All qualified providers on the MIPS track will need to do something in 2017 if they don’t want to receive the 4% negative payment adjustment on 2019 claims.
  • Regardless of the track chosen, all performance data must be submitted to CMS by March 31, 2018.

APM Track
Providers that decide to take the APM track can earn a lump sum payment of up to 5% of claims each year from 2019 – 2024. Providers that choose the APM track will also avoid MIPS reporting requirements and negative payment adjustments. To be eligible for the APM track, providers will need to receive 25% of their Medicare-covered services through an APM or see 20% of their Medicare patients through an APM in 2017. CMS has announced that the following programs qualify as an advanced APM in 2017:

  • The Comprehensive End Stage Renal Disease Care Model
  • The Comprehensive Primary Care Plus (CPC+) Model
  • The Next Generation Accountable Care Organization (ACO) Model
  • Medicare Shared Savings Program (MSSP) Tracks 2 and Track 3