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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.

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.

Alternatives:

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.

Risks:

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