MACRA MIPS Ruling October 14, 2016

CMS Finalizes the New Medicare Quality Payment Program (MACRA/MIPS)

Today, the Department of Health and Human Services (HHS) finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program. The new Quality Payment Program will gradually transform Medicare payments for more than 600,000 clinicians across the country, and is a major step in improving care across the entire health care system.

The final rule with comment period offers a fresh start for Medicare by centering payments around the care that is best for the patients, providing more options to clinicians for innovative care and payment approaches, and reducing administrative burden to give clinicians more time to spend with their patients, instead of on paperwork.

Accompanying today’s announcement is a new Quality Payment Program website, which will explain the new program and help clinicians easily identify the measures most meaningful to their practice or specialty.

What does MIPS mean for the Medicaid EHR Incentive Program?

MIPS applies to physicians and clinicians providing services under Medicare Part B. MIPS does not replace the Medicaid EHR Incentive Program, which will continue through program year 2021.  Clinicians who are eligible for the Medicaid EHR Incentive Program will continue to attest to their respective State Medicaid Agencies to receive their incentive payments. If those clinicians are also Medicare Part B clinicians, they may also participate in MIPS.

MACRA/MIPS will sunset the Medicare meaningful use payment adjustment, and there will no longer be a separate Medicare EHR Incentive Program at the end of CY 2018. As such, Medicaid EPs that fail to meet the eligibility criteria for the Medicaid EHR Incentive Program, or who fail to properly attest to meaningful use, will no longer be subject to any Medicare payment adjustments after the CY 2018 payment year. No changes were proposed to the objectives and measures previously established in rulemaking for the Medicaid EHR Incentive Program (for EPs). Finally, MIPS does not apply to hospitals or facilities – it only applies to clinicians.

More information:

Press release:

To learn more about the rule, visit:

This message was sent by the Medicaid EHR Team (MeT) on behalf of the CMS Medicaid HITECH Team. The MeT is contracted by CMS to provide technical assistance to states on their implementation of the Medicaid EHR Incentive Programs. Any questions regarding the content of this message should be directed to appropriate CMS Medicaid HITECH staff.

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