MACRA

Background: In the spring of 2015, Congress passed and the President signed into law the Medicare Access and CHIP Reauthorization Act (MACRA), which sets Medicare physician payment on a new course and resulted in significant policy changes in the next few years. MACRA was the result of a bi-partisan effort to address nearly two decades of scheduled cuts to Medicare Physician Fee Schedule (PFS) payments due to the Sustainable Growth Rate (SGR) formula. Click the image to the right for our member-exclusive resource, The ACO Guide to MACRA, detailing everything ACOs need to know about MACRA implementation. 

Overview

• In addition to repealing the SGR, MACRA provides modest but stable payment increases of 0.5 percent annually from 2015 through 2019.
• MACRA establishes the Merit-Based Incentive Payment System (MIPS), which consolidates three Medicare physician quality reporting programs (Physician Quality Reporting System, Value-Based Payment Modifier, and Meaningful Use of EHRs). MIPS is the default program for Medicare physicians.
• Those in advanced alternative payment models (APMs) are exempt from MIPS and eligible to earn an annual 5% bonus from 2019 through 2024 and a 3.5 payment in 2025.

Find the CMS page on the Quality Payment Program and its Resource Library.

NAACOS-Member Resources  

• NAACOS and co-host Capitol Hill Briefing “Speeding the Transition to Value-Based Care” on extending MACRA’s 5 percent incentive payment
• NAACOS resource on Medicare payment updates under MACRA 
  
  
• Summary of year-end bill from Congress that froze QP thresholds at 2020 levels
  
  
• NAACOS resource details Advanced APM QP calculations compared to ACO data and calculations
  
  
• New in 2019- Annual ACO CEHRT Attestation Requirement
  
  
• The 2019 version of NAACOS’s member benefit resource, The ACO Guide to MACRA details key policies in place for the 2019 performance year, which corresponds to the 2021 payment adjustment year. 
  
  
• NAACOS analysis of the final 2019 Physician Fee Schedule and Quality Payment Program rule
  

• NAACOS webinar on the Final 2019 Medicare Physician Fee Schedule Rule and Quality Payment Program: Key Issues for ACOs
  
• NAACOS-MGMA MIPS 2018 FAQs for Practices in MSSP Track 1 ACOs

CMS Resources 

• 2022 Advanced APM Incentive Payments
  
  
• CMS Shares 2020 QPP Highlights
  
  
• CMS resources on 2021 QPP Advanced APM bonuses (based on 2019 performance): Fact Sheet and Guide
  
  
• List of providers, as of June 2021, for whom CMS does not have payment information. 
  
  
• CMS 2018 Quality Payment Program Experience Report, detailing 2018 performance in MIPS and Advanced APMs
  
  
• CMS Shares New QPP Resources
  
  
• CMS resources on Advanced APMs, including the CMS QP Methodology Factsheet
  
  
• CMS factsheet on 2019 MSSP and MIPS Interactions
  
  
• 2019 MIPS Payment Adjustment Remittance Advice FAQs
  
  
• 2019 MIPS Payment Adjustment Fact Sheet
  
  
• CMS releases FAQs on Medicare Advantage Advanced Alternative Payment Model demonstration, the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI)
  
  
• CMS releases 2017 MIPS Results User Guide (see ACO specific sections on pages 7-10 and 41-45) 

• CMS provides FAQs for MSSP ACOs on the Advancing Care Information (ACI) category of MIPS

 News and Advocacy

• NAACOS responds to request from lawmakers on how to improve MACRA and expand value-based care
  
  
• NAACOS and co-host Capitol Hill Briefing “Speeding the Transition to Value-Based Care” on extending MACRA’s 5 percent incentive payment
  
  
• NAACOS Analysis of the 2022 Final Medicare Physician Fee Schedule Rule
  
  
• NAACOS analysis of the proposed 2022 Medicare Physician Fee Schedule rule 
  
  
• More than 500 ACOs, health systems, and medical practices ask Congress to freeze Advanced APM bonus thresholds at their current levels
  
  
• CMS releases final 2021 Physician Fee Schedule rule including major quality changes for ACOs
  • More detail available in this factsheet along with detailed QPP changes
  • NAACOS-issued press release on the final rule
• NAACOS and 18 other organizations ask Congress to freeze Advanced APM bonus thresholds at their current levels
  
  
• CMS releases proposed 2021 Physician Fee Schedule rule including major quality changes for ACOs
• More detail available in this factsheet along with detailed QPP changes
• NAACOS-issued press release on the proposed rule
  
  
• NAACOS Calls on CMS to Address MACRA Implementation Issues
  
  
• Nine stakeholder groups urge CMS to pay 2017 Advanced APM bonuses
  
  
• CMS published the proposed 2020 MACRA rule, which is available here along with this CMS factsheet.
  
  

• CMS publishes the final 2019 MACRA rule, which is available here along with this CMS factsheet.

• This NAACOS newsletter article pulls out key points for ACOs.
• NAACOS summary of 2019 proposed QPP and Medicare Physician Fee Schedule changes
• NAACOS webinar on the proposed 2019 changes
• NAACOS article on understanding your 2017 MIPS performance information 
  
  
• NAACOS submits comments to Ways & Means on MACRA Implementation
  
  
• The Quality Payment Program (QPP) has recently published a video demonstration of how ACO participant TINs can report ACI through the Quality Payment Program website. ACO participant practices (ACO TINs) must report ACI by the QPP submission deadline of March 31, 2018.
  
  
• NAACOS submits comments to CMS in response to final 2018 Quality Payment Program rule

• CMS releases final 2018 Quality Payment Program rule and factsheet
• NAACOS press release responds to final 2018 QPP rule
• NAACOS article provides an overview of the final QPP rule
• NAACOS in-depth analysis of the final 2018 QPP rule
• NAACOS Analysis Projects ACOs to Score in Top Tier of MIPS Performance 
  
  
• NAACOS submits comments to CMS on 2018 Quality Payment Program proposals 
  
• NAACOS Summary of the 2018 Proposed Quality Payment Program (QPP) Rule
• CMS releases proposed 2018 Quality Payment Program Rule
• CMS example of quality performance category calculation for ACOs under the MIPS APM Scoring Standard
  
  
• NAACOS APM Principles 
  
  
• NAACOS letter to CMS urges immediate credit for MA APM participation to count towards MACRA Advanced APM bonuses
  
  
• CMS releases final 2017 MACRA rule
• CMS webpage that includes final 2017 MACRA rule and many CMS QPP resources
• NAACOS in-depth analysis of the final 2017 MACRA regulation, customized specifically for ACOs. To obtain a copy of this in-depth analysis, please visit this webpage. 
• NAACOS four-part MACRA webinar series on the final 2017 QPP rule, including webinars on: MACRA Overview for ACOs, Deep Dive on Advanced APMs, Deep Dive on MIPS, and Discussion and Planning for the Future. They are available on-demand here.
• NAACOS submits comments to CMS on MACRA Final Rule with Comment Period
  
  
• CMS releases major MACRA proposed rule, detailing the proposed criteria for 2017 performance
• NAACOS outlines initial statement with concerns about CMS’s 2017 MACRA proposed rule
  
  
• NAACOS comments to CMS on proposed 2017 MACRA regulation
  
  
• ACO Cost and MACRA Implementation Survey
  
  
• NAACOS' Advanced Payment Model (APM) Talking Points 
  
  
• NAACOS comments on CMS’ MACRA request for information 
  
  
• Congresional Research Service summary of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 

To read more about developments related to MACRA and other key policy issues effecting ACOs, please visit our newsletter web page.              

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