Last week the Centers for Medicare and Medicaid Services (CMS) published the final rule on Medicaid (1,425 pages) and the proposed rule governing Medicare (962 pages), which was mandated by the Medicare Access and CHIP Reauthorization Act (MACRA). North Carolina Medical Society (NCMS) staff is carefully reading both pieces of rule-making and will be posting their full analysis and what these rules mean for you and your practice in the coming days and weeks.
MACRA Proposed Rule Outlines Vision for New Medicare Payment System
The MACRA proposal lays out CMS’ vision for the new Merit-Based Incentive Payment System (MIPS), which will replace the current quality programs as required by the MACRA legislation (i.e. PQRS, the Value Modifier and the Meaningful Use program). The proposed rule also outlines details regarding Alternative Payment Models (APMs). Certain qualifying APM participants will be eligible for 5 percent bonus payments in 2019-2024 and will be exempt from the MIPS program.
Part of the proposed restructuring of the current quality programs involves major changes to the physician EHR Incentive/Meaningful Use program, which will sunset in 2019. Instead, beginning in 2019 the MIPS program will incorporate the “advancing care information” performance category to address use of EHR technology to advance care, with an emphasis on interoperability and information exchange. CMS states this category will not include the all-or-nothing scoring currently utilized in the Meaningful Use program.
Watch the Quality Time with NCMS blog and the NCMS Bulletin for updates. The AMA also has information on their MACRA website with additional materials to assist physicians with the changes resulting from this landmark legislation. Another resource for information on these proposed changes is CMS’ listening session on the MACRA Quality Payment Program Proposed Rule on Tuesday, May 10, from 2-3 pm. To register for this session visit the MLN Connects Event Registration.
NCMS staff also recommends CMS’ new Quality Payment Program website, which includes:

Medicaid Rule Updates Medicaid Managed Care Requirements
This final rule, originally proposed last May, overhauls Medicaid managed care requirements for the first time in more than a decade, and will certainly guide North Carolina’s Medicaid reform efforts in the months ahead.
Among the provisions the rule caps insurer profits, with Medicaid managed care plans now subject to a national medical loss ratio standard of at least 85 percent, although it doesn’t impose payment penalties if plans spend less than that share of premiums on care. The rule also requires states to more rigorously supervise the adequacy of plans’ provider networks. It also encourages states to establish quality rating systems for Medicaid managed care systems. CMS will add a quality rating system for private Medicaid and CHIP plans; the program is expected to be similar to one utilized for Medicare Advantage plans. The agency plans to implement the rating system for Medicaid plans over five years and will seek feedback on its proposed methodology before moving ahead.
NCMS staff is reviewing the details of the rule and will post their analysis in the days and weeks ahead and how the new provisions will impact the state’s Medicaid reforms. Be sure to watch the Bulletin for these updates. In the meantime, CMS has put out a fact sheet under Final Rule on this website and an implementation timeline.