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HHS/CMS RIN: 0938-AS69 Publication ID: Fall 2015 
Title: ●Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) in Medicare Fee-for-Service (CMS-5517-P)(Section 610 Review) 

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.

Agency: Department of Health and Human Services(HHS)  Priority: Economically Significant 
RIN Status: First time published in the Unified Agenda Agenda Stage of Rulemaking: Proposed Rule Stage 
Major: Yes  Unfunded Mandates: No 
RFA Section 610 Review: Section 610 Review 
CFR Citation: Not Yet Determined     (To search for a specific CFR, visit the Code of Federal Regulations.)
Legal Authority: Pub. L. 114-10, sec 101   
Legal Deadline:
Action Source Description Date
Final  Statutory  MACRA deadline for requirements and policies for MIPS.   01/01/2017 
Final  Statutory  MACRA deadline for establishing physician-focused payment model criteria.  11/01/2016 

Statement of Need:

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.

Summary of the Legal Basis:

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.


None. This is a statutory requirement.

Anticipated Costs and Benefits:

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


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

Action Date FR Cite
NPRM  03/00/2016 
Regulatory Flexibility Analysis Required: Yes  Government Levels Affected: Federal, Tribal 
Small Entities Affected: Businesses, Governmental Jurisdictions, Organizations  Federalism: No 
Included in the Regulatory Plan: Yes 
RIN Data Printed in the FR: Yes 
Agency Contact:
James Sharp
Health Insurance Specialist
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicare & Medicaid Innovation Center, MS: WB-06-05, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-7388