(MACRA) Medicare Access and CHIP Reauthorization Act

Medical Industry News.

In April of 2015, after two years of cooperation between Congress, the ACC and other interest holders, the Medicare Access and CHIP Reauthorization Act (MACRA) was enacted into law.  The legislation, which touches many aspects of health care, repealed and replaced the Sustainable Growth Rate (SGR) statute and instituted a mechanism to incent clinicians to strive for value over volume. The new law integrates multiple quality reporting programs into a single system; and entitles the Children’s Health Insurance Program (CHIP) to two additional years of funding.

As of July 1, 2015, Medicare payments to clinicians were increased by 0.5 percent, and this payment will be subject to annual increases until the end of 2018. As of January 1 2019, clinicians will have the opportunity to choose between two alternatives – the Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs).

The following is a brief synopsis of what MACRA represents:

  • The SGR formula used for determining Medicare payments has ceased.
  • A period of payment increases to support a predictable evolution from fee-for-service to quality-based payment, beginning in 2019 and achieved through MIPS or APMs.
  • The participation in APMs by 2026 is encouraged by providing annual payment increases of 0.75 percent. (0.25 annual payment increases to all other clinicians)
  • The guarantee of CHIP funding through FY 2017.
  • The expansion of Medicare data usage to aid transparency and quality enhancements; and to ensure improvements in quality by providing Medicare data to qualified clinical data registries.
  • The development of quality measures by the HHS to appraise professionals, including non-patient-facing professionals.
  • Establishment of technology to accommodate an inter-operable electronic health record exchange by Dec. 31, 2018.
  • Protection for clinicians in medical liability cases.