Implementing the Medicare Access and CHIP Reauthorization Act (MACRA) - the Proposed Quality Payment Program

The Medicare Access and CHIP Reauthorization Act (MACRA) was passed by Congress and signed into law in 2015. This historic bipartisan legislation substantially supports the much-needed transition from the current volume-driven, fee-for-service (FFS) reimbursement model, to a value-based system that rewards quality and value of care over volume of services provided. MACRA included several provisions, some of which include: 

• Repeals the sustainable growth rate (SGR) methodology for determining updates to the Medicare fee schedule.
• ​Establishes two new payment tracks:
  • the Merit-based Incentive Payment System (MIPS) that retains FFS but consolidates existing Medicare quality programs
  • and Alternative Payment Models that establish a pathway for clinicians to receive incentives for participating in new delivery and payment models that migrate away from fee-for-service.

MACRA Proposed Rule Creates the Medicare Quality Payment Program

On April 27, 2016, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule (summarized in this news release), which outlines how CMS proposes to implement the law, including details regarding MIPS and APMs. This proposed rule provides an opportunity to help shape the details of the law's implementation, and the PCPCC will respond before the June 27 deadline with strong comments to support advanced primary care. (Note: PCPCC's comments will be published on our advocacy webpage once submitted to CMS.)  

Although the major provisions of MACRA begin in 2019, providers should prepare now because Medicare will use 2017 performance data for payment in 2019.

Explaining the Medicare Quality Payment Program

The U.S. Department of Health and Human Services offers an easy-to-understand video to help explain the complex regulation that is MACRA: 

The MACRA makes three important changes to how Medicare pays those who provide care to Medicare beneficiaries: 

• Ending the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services.
• Making a new framework for rewarding health care providers for giving better care not more just more care.
• Combining our existing quality reporting programs into one new system.

These changes create a Quality Payment Program (QPP). 

PCPCC Responds with Comments on MACRA Proposed Rule

On June 27, 2016, the PCPCC submitted its official comments to CMS on the MACRA proposed rule, which are summarized in a June 28 press release.

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Eager to Learn More?

Listen to Washington DC-based health care policy analyst and researcher David Introcaso's Healthcare Policy Podcast, "How CMS Proposed to Annually Update Medicare Physician Reimbursement Under MACRA: A Conversation with Mara McDermott."

For further details on MACRA, including a fact sheet on the new QPP, training slide decks, blog posts, and a downloadable timeline, visit the CMS MACRA webpage.

NOTE: PCPCC staff will continue to update this webpage as more information becomes available. Check back for further details and resources.