Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and…
Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models
SUMMARY: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the
DATES: Effective date: The provisions of this final rule with comment period are effective on
Comment date: To be assured consideration, comments must be received at one of the addresses provided below, no later than
ADDRESSES: In commenting, please refer to file code CMS-5517-FC. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. You may submit comments in one of four ways (please choose only one of the ways listed):
1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the "Submit a comment" instructions.
2. By regular mail. You may mail written comments to the following address ONLY:
Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By express or overnight mail. You may send written comments to the following address ONLY:
4. By hand or courier. Alternatively, you may deliver (by hand or courier) your written comments ONLY to the following addresses prior to the close of the comment period:
a. For delivery in
(Because access to the interior of the
b. For delivery in
If you intend to deliver your comments to the
Comments erroneously mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.
For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION:
Table of Contents
I. Executive Summary
II. Provisions of the Proposed Regulations and Analysis of and Responses to Comments
A. Establishing MIPS and the Advanced APM Incentive
B. Program Principles and Goals
C. Changes to Existing Programs
D. Definitions
E. MIPS Program Details
F. Overview of Incentives for Participation in Advanced Alternative Payment Models
III. Collection of Information Requirements
IV. Regulatory Impact Analysis
A. Statement of Need
B. Overall Impact
C. Changes in Medicare Payments
D. Impact on Beneficiaries
E. Impact on Other Health Care Programs and Providers
F. Alternatives Considered
G. Assumptions and Limitations
H. Accounting Statement
Acronyms
Because of the many terms to which we refer by acronym in this rule, we are listing the acronyms used and their corresponding meanings in alphabetical order below:
APM Alternative Payment Model
APRN Advanced Practice Registered Nurse
BPCI Bundled Payments for Care Improvement
CAHPS Consumer Assessment of Healthcare Providers and Systems
CBSA Non-Core Based Statistical Area
CDS Clinical Decision Support
CEHRT Certified EHR technology
CFR Code of Federal Regulations
CHIP
CJR Comprehensive Care for Joint Replacement
COI Collection of Information
CPIA Clinical Practice Improvement Activity
CPOE Computerized Provider Order Entry
CPR Customary, Prevailing, and Reasonable
CPS Composite Performance Score
CPT Current Procedural Terminology
CQM Clinical Quality Measure
CY Calendar Year
eCQM electronic Clinician Quality Measure
EHR Electronic Health Record
EP Eligible Professional
ESRD End-Stage Renal Disease
FFS Fee-for-Service
GAO
HIE Health Information Exchange
HIPAA Health Insurance Portability and Accountability Act of 1996
HITECH Health Information Technology for
HPSA Health Professional Shortage Area
IHS Indian Health Service
IT Information Technology
MACRA Medicare Access and CHIP Reauthorization Act of 2015
MEI Medicare Economic Index
MIPAA Medicare Improvements for Patients and Providers Act of 2008
MIPS Merit-based Incentive Payment System
MLR Minimum Loss Rate
MSPB Medicare Spending per Beneficiary
MSR Minimum Savings Rate
MUA Medically
NPI National Provider Identifier
OCM Oncology Care Model
PECOS Medicare Provider Enrollment, Chain, and Ownership System
PFPMs Physician-Focused Payment Models
PFS Physician Fee Schedule
PHS
PQRS Physician Quality Reporting System
QCDR Qualified Clinical Data Registry
QP Qualifying APM Participant
QRDA Quality Reporting Document Architecture
QRUR Quality and Cost Reports
RBRVS Resource-Based Relative Value Scale
RFI Request for Information
RIA Regulatory Impact Analysis
RVU Relative Value Unit
SGR Sustainable Growth Rate
TCPI Transforming Clinical Practice Initiative
TIN Tax Identification Number
VM Value-Based Payment Modifier
VPS Volume Performance Standard
I. Executive Summary
1. Overview
--This is a summary of a
Final rule with comment period.
CFR Part: "42 CFR Parts 414 and 495"
RIN Number: "RIN 0938-AS69"
Citation: "81 FR 77008"
Document Number: "CMS-5517-FC"
Federal Register Page Number: "77008"
"Rules and Regulations"
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