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CMS Publishes Final MACRA Quality Payment Program Rule

On November 2, the Centers for Medicare & Medicaid Services (CMS) published their final Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program (QPP) Rule, a value-based payment system under which eligible clinicians can participate in Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS). The final version of the Rule included three changes that are in line with the recommendations C-TAC made during CMS’s comment seeking period. These recommendations include:

  • That the Cost category for the Merit-Based Incentive Payment System (MIPs) be returned to the previous 10% level because controlling cost promotes more appropriate and efficient care.
  • That the weighting for the MIPS Improvement Activity “Provide 24/7 access to MIPS ECs or Groups Who Have Real-Time Access to Patient’s Medical Record” be kept at “high”, vs being reduced to “medium”, as 24/7 access is mandatory to help address people’s issues before they become crises needing an emergency department visit or hospitalization and keeping this activity’s weight as “High” will incentivize providers to build systems for such 24/7 access.
  • That a bonus for caring for Complex Patients be added and increased from the proposed 3 to 5 points, since developing a short-term bonus is helpful to reward providers for caring for people with complex illness and 5 points more truly reflects the additional effort such patients require

To read more about the MACRA QPP Rule and C-TAC’s work with CMS, see the blog post written by C-TAC’s Senior Regulatory Advisor, Dr. Marian Grant.

CMS also released the Final Physician Fee Schedule (PFS) Rule for 2018  and acknowledged the following comments brought forth by C-TAC:

  • Our support for the new Care Coordination Services and payment for Rural Health Clinics and Federally-Qualified Health Centers for general behavioral health integration and psychiatric collaborative care model services furnished in these facilities. Behavioral health is much needed for people cared for by such centers and the current codes do not adequately reimburse providers for the time and effort they can take.
  • Our support for separate payment for CPT codes for remote patient monitoring via telehealth as this will help those with advanced illness have key symptoms assessed and managed, which can prevent acute crises that often necessitate ED visits or hospitalizations.

For more information about C-TAC policy and advocacy activities, please contact Andrew MacPherson at AMacPherson@thectac.org, Marian Grant at mgrant@thectac.org, or Ziya Smallens at ZSmallens@thectac.org.

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