Press Releases

CMS Advances Demonstration to Waive MIPS Requirements for Clinicians in Certain At-Risk Medicare Advantage Plans

Today, the Centers for Medicare & Medicaid Services (CMS) is advancing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, which, when approved and adopted, would waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians who participate sufficiently in certain Medicare Advantage plans that involve taking on risk. CMS seeks public comment on the information collection burdens associated with the demonstration, which is under consideration for formal approval.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) provides clinicians with two tracks for payment under Fee-for-Service Medicare: MIPS, which requires clinicians to report quality data to CMS and have their payment adjusted accordingly; and Advanced Alternative Payment Models (Advanced APMs), which require clinicians to take on risk for their patients’ healthcare spending.

Some Medicare Advantage plans are developing innovative arrangements that resemble Advanced APMs. However, without this demonstration, physicians are still subject to MIPS even if they participate extensively in Advanced APM-like arrangements under Medicare Advantage.

“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.”