September 12, 2016
On September 8, 2016, the Centers for Medicare & Medicaid Services (CMS) announced updated 2017 MACRA participation options via the CMS blog.
The MACRA Proposed Rule released on April 27, 2016, proposed a performance period of January 1-December 31, 2017 in which all MIPS eligible clinicians would be required to submit specified data to be used for the first MACRA payment adjustment in 2019. In that year, eligible clinicians participating in the Merit-based Incentive Payment System (MIPS) would have payments updated +/- 4 percent depending upon performance relative to their peers. Qualifying participants in Advanced Alternative Payment Models (APMs) would receive a 5 percent lump sum bonus.
In an unusual informal announcement via the agency’s blog and in advance of a final rule, CMS announced several significant changes to its original proposal, providing clinicians participating in the MIPS track with new options to ease into reporting obligations and eliminating downside risk in the first year for those who report at least some data. For the 2017 performance period that will impact payment adjustments in 2019, CMS plans to provide the following participation options.
* CMS proposed to require all eligible providers to submit MIPS performance data in 2017.
Download chart here.
Notably, CMS seems to be offering this flexibility only for the first performance period, 2017. Presumably, eligible clinicians would be expected to participate fully by 2018, or face payment penalties as described in the proposed rule.
Under the proposed rule, unless eligible for a reporting exception, payments to MIPS eligible clinicians will be reduced to the maximum amount if no data is submitted. The recent blog post announces no change for non-reporters.
There are a number of details left off of this brief announcement. For example, the announcement does not define the number of days you will need to submit in order to qualify for Option 2. Beyond clearly stating that participating in one of the options described above will avoid a negative adjustment, it does not clearly state the range of positive payment adjustments for Options 2 and 3. Additionally, since by statute MIPS is budget neutral, how budget neutrality will be implemented under these scenarios is also not addressed. These questions presumably will be answered when the agency releases the final rule sometime before November 1st.
CMS’s announcement in advance of a final rule comes amidst pleas from physician groups to slow the implementation and provide more flexibility for physicians who may not be ready to fully participate in the program. Similar pressure is also coming from Congress. The agency is clearly seeking to get ahead of this criticism, and to signal to the affected community that the final rule may not be as rigid and worrisome as the proposed rule.
More information on MACRA can be found at the McDermottPlus MACRA Resource Center.