On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released the final rule with detailed regulations to implement the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. This law repealed the flawed Medicare Sustainable Growth Rate (SGR) formula that had served as the underpinning of Medicare physician payment for many years. MACRA replaced the SGR with the Quality Payment Program (QPP).

The QPP program has two pathways for compliance. 1) Merit-Based Incentive Payment System (MIPS) or 2) Alternative Payment Model (APM). Physicians and other eligible providers must choose to participate in one of these programs to avoid a Medicare payment penalty in 2019.

If you choose MIPS, you may choose to start between January 1, 2017 and October 2, 2017, depending on your level of readiness. You may report just one quality measure, 90 days worth of data, or a year of data. It is up to the provider. All reporting of performance data must be complete by March 31, 2018.

If you are part of an Advanced Payment Model, you may earn a five percent bonus payment in 2019. Importantly, CMS is looking to broaden APMs to include participation by medical specialists.

CMS published an executive summary of this complex rule. We encourage all members to review this summary and the CMS Fact Sheet.

CMS has also launched a new QPP website. Please make use of this comprehensive CMS MACRA resource.

HFSA will continue to review the rule and provide updates to members.