CMS to waive MACRA's alternative payment model requirements for Medicare Advantage under test

CMS moved to allow some physicians who participate in risk-bearing Medicare Advantage plans to qualify as an advanced alternative payment model under the Medicare Access and CHIP Reauthorization Act, the agency said June 29.

The announcement follows criticism from large health groups, who claim while physician groups have to reach a 25 percent revenue threshold in traditional Medicare to qualify for the advanced APM track under MACRA, physicians operating in areas with large Medicare Advantage populations are unable reach this threshold. The groups argue even though they are taking on risk through innovative agreements resembling advanced APMs, they do not qualify for an Advanced APM track, and therefore have urged HHS to treat risk contracts the same for Medicare and Medicare Advantage providers.

By advancing the Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration, CMS plans to waive Merit-Based Incentive Payment System participation requirements for qualifying providers.

"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," CMS Administrator Seema Verma said. "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."

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