The Centers for Medicare & Medicaid Services (CMS) is advancing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, which, when approved and adopted, would waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians who participate sufficiently in certain Medicare Advantage plans that involve taking on risk.
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.
Indeed, CMS is continuing to show a desire to push providers into taking on more risk. According to CMS, “Some Medicare Advantage plans are developing innovative arrangements that resemble Advanced APMs. However, without this demonstration, physicians are still subject to MIPS even if they participate extensively in Advanced APM-like arrangements under Medicare Advantage.”
The MAQI program is still waiting formal approval; but in a statement, CMS Administrator Seema Verma noted that it aligns with the agency’s goal of moving to a value-based healthcare system, and aims to put Medicare Advantage on a more equal playing field with fee-for-service Medicare. “CMS intends to test whether MIPS exemptions provided to clinicians under MAQI will increase participation in Medicare Advantage plans that are similar to Advanced APMs, and thereby accelerate the transition to a healthcare system that pays for value and outcomes,” Verma stated.
Recently, CMS stated that 91 percent of all MIPS-eligible clinicians participated in the first year of the Quality Payment Program (QPP), exceeding the agency’s internal goal. Ultimately, the goal will be to move providers toward advanced alternative payment models in later years of the QPP.
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