On April 1, the Centers for Medicare & Medicaid Services (CMS) sent draft regulations to the White House Office of Management and Budget (OMB), the final step to releasing a proposed rule for the implementation of critical changes introduced in last year’s Medicare Access and CHIP Reauthorization (MACRA) law.
Currently titled “Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) in Medicare Fee-for-Service,” the proposed rule will affect Medicare’s meaningful use, PQRS, and ACO programs, among others. Earlier this year, the head of HHS presaged the implementation of MIPS as a game-changing event for physicians and other healthcare providers, as various quality and incentive programs become part of a new value-based payment model.
OMB review is the final step before the publication of proposed regulations for public comment. Under the law, regulations sent to OMB must be released within 90 days, though a shorter timeframe is certainly possible, as CMS will look to publish a final rule before a new president takes office.
These new regulations will be the first step in establishing critical changes introduced in last year’s MACRA law. The proposed rule is expected to replace the payment and penalty structure of existing programs with a new merit-based program that utilizes a composite “MIPS score” based on quality reporting, meaningful use of certified EHR, and participation in clinical improvement programs, such as Accountable Care Organizations (ACOs) and patient centered medical home (PCMH).
Based on MIPS scores, providers will see positive or negative adjustments to Medicare payments.
Impact for NextGen Healthcare clients
Through MACRA and related policy and regulations, the healthcare market will see new value-based reimbursement programs and an accelerated shift toward value-based payments over the next several years. By supporting existing programs and initiatives such as MU, PQRS, ACOs, PCMH, and more, NextGen Healthcare has been helping clients prepare for this long-anticipated shift.
NextGen Healthcare will analyze the proposed regulations upon publication and provide information to clients, as well as further refining our strategy for helping clients meet the demands of a changing healthcare system.