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CMS Demonstration Would Waive MIPS Requirements

The Centers for Medicare & Medicaid Services (CMS) advanced a demonstration project that would waive Merit-based Incentive Payment System (MIPS) requirements for clinicians who participate in certain Medicare Advantage plans that involve taking on risk.

The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration is under consideration for formal approval and CMS seeks public comment on information collection burdens associated with the project.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) provides clinicians with two tracks for payment under fee-for-service Medicare:

  • MIPS, which requires clinicians to report quality data to CMS and have their payment adjusted accordingly; and
  • advanced alternative payment models (Advanced APMs), which require clinicians to take on risk for their patients’ healthcare spending.

Some Medicare Advantage plans are developing innovative arrangements that resemble Advanced APMs. However, physicians participating extensively in Advanced APM-like arrangements under Medicare Advantage still are subject to MIPS.

The agency plans to evaluate whether the MAQI demonstration increases participation of Medicare Advantage plans that are similar to Advanced APMs. CMS said the MAQI demonstration aligns with the agency’s goals to advance value-based health care and align Medicare Advantage with fee-for-service Medicare.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Michelle Rosenfeld is senior writer/editor at America's Essential Hospitals.