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CMS Will Waive MIPS for Doctors Who Agree to More Medicare Advantage Risk

Allison Inserro

CMS said Friday it is launching a demonstration of its Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI), which pushes Medicare Advantage (MA) providers into taking on more risk. The demonstration, which has to be approved and adopted, would waive Merit-based Incentive Payment System (MIPS) requirements for doctors opting into the new program.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) provides clinicians with 2 tracks for payment under fee-for-service (FFS) Medicare through the Quality Payment Program (QPP): MIPS, which requires clinicians to report quality data to CMS and have their payment adjusted accordingly; and advanced alternative payment models (A-APMs), which require clinicians to take on risk for their patients’ healthcare costs.

“The MAQI Demonstration 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,” said CMS Administrator Seema Verma. “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.”

CMS said some MA plans are developing innovative arrangements that resemble A-APMs. However, without this demonstration, physicians are still subject to MIPS even if they participate extensively in arrangements like an A-APM under MA. The agency said it is seeking public comment on the burdens associated with the demonstration.

Earlier this month, a collection of 11 health groups sent a letter to Adam Boehler, the director of the Center for Medicare and Medicaid Innovation Center, urging HHS to recognize physician participation in MA toward participation criteria for the A-APM model track of MACRA's QPP.

Verma has previously said 91% of all clinicians eligible for MIPS participated in the first year of the QPP, surpassing the agency’s goal of 90%. The agency raised 2019 insurer payments to MA plans in April.

Unlike Medicare FFS, MA beneficiaries receive additional benefits, such as coverage for prescription drugs, vision, hearing, dental, and wellness care. In addition, CMS is allowing payments for services tied to social determinants of health, such as meal delivery and transportation to appointments. Compared with FFS plans, beneficiaries in MA plans tend to be more diverse and also low-income.
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