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CMS Issues 2018 MACRA Implementation, Quality Payment Program Rule

A new final MACRA implementation rule details Quality Payment Program requirements in 2018, particularly for MIPS.

MACRA implementation and Quality Payment Program

Source: Thinkstock

By Jacqueline Belliveau

- CMS recently issued a final 2018 MACRA implementation rule, detailing the requirements for Quality Payment Program participation in 2018.

“CMS listened to feedback from the healthcare community and used it to inform policy making,” the federal agency stated in an emailed press release. “As a result, the Year 2 final rule continues many of the flexibilities included in the transition year, while also preparing clinicians for a more robust program in Year 3. CMS wants to ensure that the program consists of meaningful measurement while minimizing burden, improving coordination of care, and supporting a pathway to participation in Advanced Alternative Payment Models (APMs).”

Major Quality Payment Program provisions pertaining to the program’s Merit-Based Incentive Payment System (MIPS) in the rule include:

• MIPS Cost performance category will account for 10 percent of the total MIPS score, up from zero percent in the first performance year

• MIPS performance threshold will increase from 3 points during the “Pick Your Pace” transition year to 15 points in 2018

• Eligible clinicians can use 2014 Edition and/or 2015 Certified EHR Technology (CEHRT) for attestation to the MIPS Advancing Care Information category, with clinicians using the 2015 version earning bonus points

• Eligible clinicians treating medically complex patients will earn an award up to 5 bonus points

• MIPS Quality, Advancing Care Information, and Cost categories will not affect MIPS scores of eligible clinicians affected by Hurricanes Irma, Harvey, and Maria, as well as other natural disasters

• Small practices will receive 5 bonus points to their total MIPS score

• Virtual group implementation will launch during the second performance year

• Quality Payment Program participation thresholds will exclude more clinicians, by excluding eligible clinicians or groups with less than $90,000 in Part B allowed charge or fewer than 200 Medicare Part B beneficiaries

In terms of the Advanced Alternative Payment Model pathway, the final rule provided additional information on how eligible clinicians can join an approved model under MIPS and be evaluated under the MIPS APM scoring standard.

CMS also included additional flexibilities and pathways for clinicians to participate in the new All Payer Combination Option, which extends the Advanced Alternative Payment Model track beyond Medicare. However, these models will not be available until the 2019 performance year.

“The final rule with comment further advances the agency’s goals of regulatory relief, program simplification, and state and local flexibility in the creation of innovative approaches to healthcare delivery,” CMS stated.

To view the complete final rule, click here.

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