Beyond MIPS and APMs: Everything else you should know about MACRA


The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, is getting a lot of press these days—and deservedly so. The bipartisan legislation is responsible for many key moves in Medicare payments, including repealing the Sustainable Growth Rate (SGR) and stabilizing Medicare payments for physicians by securing positive updates through 2019 and again in 2026 and beyond.

In our last post, we reviewed the two tracks MACRA designated that will determine Medicare payments beginning in 2019, the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) participation. But MACRA has also finalized a number of other key provisions related to quality measure development, extensions for various Medicare programs, other health related funding extensions, and the Children’s Health Insurance Program (CHIP).

Since reading through the details of a several hundred page law is not everyone’s cup of tea, we have outlined some of the key provisions that were finalized in MACRA that physicians and other healthcare industry professionals should know about.

Quality measurement and Medicare extender provisions

  • $30 million in funding a year from FY 2015 through FY 2017 was designated for the National Quality Forum to support quality measure endorsement, input, and selection.
  • $15 million per year from FY 2015 to FY 2019 could go to physicians, physician groups, and the Physician Consortium for Performance Improvement (PCPI) to support quality measure development.
  • Funding was finalized through September 30, 2017, for Medicare education through State Health Insurance Programs, Area Agencies on Aging, Aging and Disability Centers, the National Center for Benefits Outreach and Enrollment, and other programs.
  • The 3% add-on for home health services in rural areas was extended until January 1, 2018.

Other health extender provisions

  • The qualifying individual program that subsidizes Medicare Part B premiums for beneficiaries earning 120-135% of federal poverty levels is now permanent.
  • Funding was extended through FY 2017 for the Type I Diabetes and Type II Indian Health Service programs.
  • Funding was extended through FY 2017 for family-led organizations to serve other families of children with disabilities and other special health care needs.
  • States will not be able to begin recovering third-party liability settlements and judgments received by Medicaid beneficiaries until October 1, 2017.

Children’s Health Insurance Program (CHIP) provisions

  • The CHIP program has funding expanded for two years, through FY 2017. CHIP is currently serving over 8 million children and low-income pregnant women, the Child Enrollment Contingency Fund, and the qualifying states option that lets states expand Medicaid to children using CHIP funds.
  • Funding was extended through FY 2017 for the childhood obesity demonstration project and the pediatric quality measures program.

Medicare beneficiary reforms and other cost offsets

  • Medicare beneficiaries with higher incomes will start paying more premium costs (under Medicare Parts B and D) starting in 2018. These will be subject to inflation adjustments beginning in 2020.
  • A 3.2% increase in the base rate for inpatient hospital payments (scheduled for fiscal year 2018 under the American Taxpayer Relief Act of 2012) will instead be phased in at 0.5% per fiscal year, from 2018 through 2023.

Keep an eye on this blog by signing up for our newsletter to stay informed of details related to MIPS, APMs, and other provisions of MACRA as they roll out.

Further reading:
How using the MIPS 90-day reporting period will increase your 2017 Composite Score
Avoiding a penalty in 2018 MIPS: the nuts and bolts

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