The CMS Innovation center (CMMI) recently announced the development of a new payment and delivery model to improve the effectiveness and efficiency of specialty healthcare. The new Oncology Care Model (OCM)1 one of several models being developed by CMMI requires participating physician practices that administer chemotherapy to enter into payment agreements with CMS to measure financial and performance accountability for episodes of care.

Location: United States

Adopted the Medicaid Expansion: 30 states (including DC); Adoption of the Medicaid Expansion Under Discussion: 3 states; Not Adopting the Medicaid Expansion at this Time: 18 states

On April 14, 2015, President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) into law –definitively repealing the troubled Sustainable Growth Rate (SGR) formula. AAFP and CAFPfought hard to ensure MACRA’s passage; now we will ensure that family physicians understand the new law and have the resources to respond to future changes in Medicare payment.

In April 2015, the President signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (HR 2, also known as MACRA). This law:

Congress should help improve access to primary care for patients enrolled in Medicaid by restoring Medicaid Primary Care Pay Parity. Senators should co-sponsor the Ensuring Access to Primary Care for Women & Children Act (S. 737), and House members co-sponsor the companion legislation (H.R. 2253), and then expedite action by both chambers to pass the legislation. This bill ensures Medicaid payments for primary care and immunization services are reimbursed at no less than what Medicare pays for the same services. 

For 2013 and 2014, the federal government raised payment rates to Medicaid primary care providers. Only some states plan to extend the rate increase.

What's the issue?

1. How does the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact Medicare payments to physicians?

This law repeals the flawed Medicare sustainable growth rate (SGR) formula that calculates payment rates to physicians. It also establishes an alternative set of annual payment updates to replace the SGR:

Abstract

The Medicare Access and CHIP Reauthorization Act (MACRA), H.R. 2 was passed overwhelmingly by the House of Representatives on March 26, 2015 by a vote of 392 to 37, approved by the Senate on April 14 by a vote of 92 to 8, and then signed by the President on April 16. This law not only eliminates the failed Medicare Sustainable Growth Rate (SGR) formula, but also fundamentally revamps how Medicare pays physicians. So, what is actually included in this new law and why should physicians support and get prepared for it?