0938-AS69 201510 The Regulatory Plan and the Unified Agenda of Federal Regulatory and Deregulatory Actions 0938 Centers for Medicare & Medicaid Services CMS 0900 Department of Health and Human Services HHS Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) in Medicare Fee-for-Service (CMS-5517-P)

This proposed rule would implement provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) related to MIPS and APMs.  Section 101 of MACRA authorizes a new MIPS, which repeals the Medicare sustainable growth rate and improves Medicare payments for physician services.  MACRA consolidates the current programs of the Physician Quality Reporting System, the Value-Based Modifier, and the Electronic Health Records Incentive Program into one program, MIPS, that streamlines and improves on the three distinct incentive programs.  Additionally, MACRA authorizes incentive payments for providers who participate in eligible APMs.

]]> Economically Significant First Time Published in The Unified Agenda Proposed Rule Stage Yes No Section 610 Review Not Yet Determined Pub. L. 114-10, sec 101 Statutory Final 01/01/2017 MACRA deadline for requirements and policies for MIPS. Statutory Final 11/01/2016 MACRA deadline for establishing physician-focused payment model criteria. Yes

Under MACRA, payment adjustments to eligible professional (EP) payments through MIPS and incentive payments for qualifying APM participants will be applied beginning January 1, 2019. EPs under MIPS will be assessed a payment adjustment using four performance categories: quality, resource use, clinical practice improvement activities, and meaningful use of certified electronic health record (EHR) technology. Qualifying APM participants must have a specified amount of their Medicare expenditures or patients through an eligible APM that meets legislative criteria that include quality measures comparable to those in MIPS, required use of certified EHR technology, and either more than nominal financial risk or a structure as a medical home model. Additionally, specific to physician-focused APMs, the legislation creates a Technical Advisory Committee whose role is to receive and evaluate proposed APMs from the public and requires that the Secretary establish criteria for physician-focused payment models, including models for specialist physicians, by November 1, 2016.

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Section 101 of MACRA requires proposed and final rules be published by November 1, 2016, for release of criteria for publicly submitted physician-focused payment models and for the release of the MIPS quality measure list.

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None. This is a statutory requirement.

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As we move toward publication, estimates of the cost and benefits of these provisions will be included in the rule.

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If this regulation is not published timely, physicians would not have adequate time to prepare for the MIPS.

]]> NPRM 03/00/2016 Yes Businesses Governmental Jurisdictions Organizations Federal Tribal No Yes No James Sharp Health Insurance Specialist 0938 Centers for Medicare & Medicaid Services CMS 410 786-7388 james.sharp@cms.hhs.gov Center for Medicare & Medicaid Innovation Center, MS: WB-06-05, 7500 Security Boulevard, Baltimore MD 21244