MACRA Information

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MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, or "the doc fix" is an important piece of legislation that will impact how APRNs are reimbursed for services. 

  • On May 9, 2016, the Centers for Medicare & Medicaid Services (CMS) proposed a rule to implement MACRA requirements.
  • The proposed rule has generated significant concern and interest, with some calling for changes or delays in implementation.
  • On June 27, 2016, ANA submitted a letter to CMS on the proposed rule to implement MACRA requirements.
  • CMS has recently announced that CMA will offer an array of reporting options for the Merit-Based Incentive Performance Systems. Choosing any one of the four identified options will allow providers to avoid a negative payment adjustment in 2019. The options will be fully explained in the final rule.
  • On September 8, 2016, CMS announced that in response to the comments received on the proposed rule, the final rule will offer an array of reporting options for clinicians. Participation in any one of the four identified options will allow eligible clinicians to avoid a negative payment adjustment in 2019. The four options will be fully explained in the final rule, scheduled for publication by November 1, 2016.
  • Learn more about the proposed rule and how the changes under this law might impact your practice by reviewing the information in the links below
  • Check back here to learn more about ANA's advocacy, review updated information on the implementation of MACRA, and read ANA's comments on the proposed rulee to learn more about ANA's advocacy, review updated information on the implementation of MACRA, and read ANA's comments on the proposed rule.
What Nurses Need to Know

i. MACRA – What Is It?
ii. Merit-Based Incentive Payment System (MIPS)
iii. Alternative Payment Models (APM)
iv. Physician-Focused Payment Model Technical Advisory Committee (PTAC)

Additional Resources

Proposed Rule issued on May 9, 2016 – text of proposed rule
See: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models

CMS Fact Sheet on Proposed Rule
See: CMS Fact Sheet: Medicare Access and CHIP Reauthorization Act of 2015 Quality Payment Program

CMS PowerPoint slides
See: CMS MACRA Overview (slides)

CMS Fact Sheet on Merit-Based Incentive Payments
See: CMS Fact Sheet details proposals for the Merit-based Incentive Payment System (MIPS) performance category focused on the use of electronic health records: Advancing Care Information. This proposal would replace the Meaningful Use program

CMS Website on Delivery System Reform, Medicare Payment Reform, & MACRA
See: CMS MACRA Resources

Health Affairs’ Health Policy Brief: Medicare’s New Physician Payment System. A 2015 law has the potential to transform how Medicare pays physicians.

Alliance for Health Reform Briefing Materials: MACRA: New Directions for Medicare Physician Payment

ANA Comments on CMS Request for Information on MACRA – ANA Response
On October 1, 2015, CMS issued a Request for Information (RFI) regarding implementation of the Merit-Based Incentive Payment System, Promotion of Alternative Payment Models, and Incentive Payments for Participation in Eligible Alternative Payment Models.

See: ANA comments on the RFI (dated November 16, 2015) and letter to CMS from an APRN Workgroup.

For information on the health information technology implications of MACRA and background information on the use of certified electronic health records (EHRs), see the following:

HIMSS (Healthcare Information and Management Systems Society) MACRA Resource Center
CMS Certified EHR Technology
ONC Health IT Certification Program
CMS MACRA and Delivery System Reform, The Health IT Policy Committee Kate Goodrich, MD MHS (May 17, 2016)

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