Medicare Access and CHIP Reauthorization Act of 2015: What You Need to Know
Heart of Health Policy | In April, President Barack Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which permanently repeals the Sustainable Growth Rate (SGR), establishes a framework for rewarding clinicians for value over volume, streamlines quality reporting programs into one system and reauthorizes two years of funding for the Children’s Health Insurance Program (CHIP).
MACRA’s passage into law is a culmination of over two years of close collaboration with members of Congress on both sides of the aisle and a broad array of stakeholders, including the ACC. The law touches upon many areas across the health care spectrum.
As with any law, the language of MACRA is drafted with a high degree of flexibility to allow medical specialty organizations like the ACC to work closely with the Department of Health and Human Services (HHS) through the regulatory process to establish how the law will function. The passage of the law represents only the first step in a long process, albeit an important one.
Beginning July 1, clinicians will begin receiving a 0.5 percent increase to Medicare payments. This payment increase will continue annually until Dec. 31, 2018. Starting in 2019, clinicians will choose from one of two pathways: the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs).
What MACRA Does
- Repeals the flawed SGR formula used for determining Medicare payments to clinicians. The SGR henceforth does not exist.
- Establishes a period of positive payment increases by providing an annual 0.5 percent payment increases for clinicians to support a predictable transition from fee-for-service to quality-based payment.
- Promotes the transition to quality-based payment by implementing two payment pathways for clinicians beginning in 2019: the new MIPS or an APM.
- Supports participation in APMs by providing annual payment increases of 0.75 percent to those participating in a qualifying APM in 2026 and beyond, and 0.25 annual payment increases to all other clinicians.
Other provisions included in MACRA include:
- Reauthorization of funding for CHIP for two years through fiscal year 2017.
- Delayed enforcement of the “two-midnight” rule until Oct. 1. Until then, contractors may only review claims to probe and educate, and claims submitted before Oct. 1 will not be subject to post-payment reviews by Recovery Audit Contractors. The “two-midnight” rule required patients spend at least two nights in the hospital to be considered inpatient for reimbursement purposes.
- Prohibition of implementation of 2015 Medicare Physician Fee Schedule provisions requiring the transition of all 10-day and 90-day global surgical packages to 0-day global periods.
- Expansion of the use of Medicare data for transparency and quality improvement by removing barriers and allowing for Medicare data to be provided to qualified clinical data registries to facilitate quality improvement.
- Requirements that the HHS Secretary draft a plan for development of quality measures to assess professionals, including non-patient-facing professionals.
- Declaration of a national objective to achieve widespread exchange of health information through interoperable certified electronic health record technology nationwide by Dec. 31, 2018.
- Provision to protect clinicians by preventing quality program standards and measures (such as PQRS/MIPS) from being used as a standard or duty of care in medical liability cases.
Learn more about how this legislation will impact you and your practice on ACC.org.
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