Medicare_Access_and_CHIP_Reauthorization_Act_of_2015

Medicare Access and CHIP Reauthorization Act of 2015

Medicare Access and CHIP Reauthorization Act of 2015

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Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), (H.R. 2, Pub. L.Tooltip Public Law (United States) 114–10 (text) (PDF)) commonly called the Permanent Doc Fix, is a United States statute. Revising the Balanced Budget Act of 1997, the Bipartisan Act was the largest scale change to the American health care system following the Affordable Care Act in 2010.[1]

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Provisions

MACRA's primary provisions are:

MACRA related regulations also address incentives for use of health information technology by physicians and other providers. It created the Medicare Quality Payment Program.[2] Clinicians can choose to participate in the Quality Payment Program through the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).[3] MIPS is an incentive program that consolidates three incentive programs into one, for eligible physicians. APMs allow clinicians to earn incentives for participating in innovative payment models.[3][4] In 2026, the conversion factor for both programs will be set at 0.75%.

The Government Accountability Office in partnership with DHHS is set to assist in the implementation of nationwide electronic health records[5] (EHR), while simultaneously comparing and recommending such programs for providers; the EHR goal is set for December 31, 2018 under MACRA.[citation needed]

The US is set to transition from a fee for service system, which allowed physicians and providers to bill Medicare and Medicaid for services they provided to their patients, to a pay for performance based system using MIP, APM, and Accountable Care Organizations (ACO).

Legislative History

Enacted on April 16, 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) represents a landmark bipartisan effort to reform Medicare payments, emphasizing a shift from volume-based reimbursements to a system that rewards quality and value in healthcare.[6]

References

  1. [1]
    Zelman, William N. (2020). Financial management of health care organizations : an introduction to fundamental tools, concepts and applications. Michael J. McCue, Noah D. Glick, Marci S. Thomas (5th ed.). San Francisco, CA. p. 21. ISBN 978-1-119-55384-7. OCLC 1128885979.{{cite book}}: CS1 maint: location missing publisher (link)
  2. [2]
    Liao, Joshua M.; Navathe, Amol S.; Werner, Rachel M. (2020). "The Impact of Medicare's Alternative Payment Models on the Value of Care". Annual Review of Public Health. 41: 551–565. doi:10.1146/annurev-publhealth-040119-094327. PMID 32237986.
  3. [3]
    "Quality Payment Program". Centers for Medicare & Medicaid Services. 23 March 2020. Retrieved 12 September 2020.
  4. [4]
    "MACRA: MIPS & APMs". www.cms.gov. 7 August 2017.
  5. [5]
    H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015
  6. [6]
    Klausen, Kevin (2024-01-16). "What Is MACRA? A Comprehensive Overview - Assurance IQ". assurance.com. Retrieved 2024-02-14.
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