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November 2016


Making Sense of the MACRA Final Rule

Part 3 of 3: Merit Based Payment Incentive System (MIPS)







For more information about this e-Alert, please contact:


Stephen M. Angelette


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Bruce A. Johnson


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Amy McCullough


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Cybil G. Roehrenbeck


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Rebecca Frigy Romine


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Sidney Welch


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Related eAlerts:
Making Sense of the MACRA Final Rule

Part 1 of 3: Essential Concepts

Part 2 of 3: Alternative payment Models


Related Webinar:
MACRA Final Rule: Key Implications and Strategies for Success - 11.10.2016
presented by:
Bruce A. Johnson and
Sidney Welch

For more information or to register, click here.


To learn more about our Health Care practice, to contact one of our Health Care attorneys, or for more Health Care Intelligence, click here.


To learn more about our Public Policy practice, or to contact one of our Public Policy attorneys, click here.


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The Centers for Medicare & Medicaid Services (CMS) recently released its final rule with comment period implementing the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Among its numerous changes, MACRA replaced the Medicare sustainable growth rate (SGR) formula with a new system that links Medicare fee for service (FFS) payments for physician and other clinicians’ services to care delivery, quality and value-based variables.

This article is part of a three-part series that examines various legal, operational and strategic details and considerations related to MACRA based on the unpublished version of the final rule submitted to the Office of Management and Budget on Oct. 14, 2016. The final rule was published in the Federal Register on Nov. 4, 2016.

Separate articles in this series examine:

  • Essential elements of the QPP, including its policy objectives, alternative participation vehicles, and key operational choices (MACRA Essential Elements), and
  • MACRA’s Alternative Payment Model (APM) participation vehicle.

This article addresses:

Observations and Additional Information

In the final rule CMS sought to balance several potentially conflicting goals and objectives:

  • The agencies’ self-defined goal to set priorities and timelines to link 90 percent of Medicare FFS payments to quality or value by the end of 2018,
  • Massive amounts (over 4,000) public comments from stakeholders in response to the highly complex proposed rule; and
  • A practical need and legislative mandate to begin implementing the bi-partisan MACRA legislation beginning on Jan. 1, 2017.

Overall, given the complexity of MACRA, the final rule and the 2017 transition plan for MIPS in particular represents a pragmatic, but imperfect, approach to implementation. On this final point, CMS observes and acknowledges that the final rule and the specific details of the MIPS and APM participation vehicles for the QPP will continue to change and evolve in the years ahead.

Consult Polsinelli’s separate articles dealing with the final rule’s requirements and practical implications associated with APMs and MIPS here.

The final rule is subject to a 60-day comment period following its publication in the Federal Register on Nov. 4, 2016, so comments are due on Dec. 19, 2016.

To view or download a pdf of the full alert, please click here.

Sign up to participate in Polsinelli's Reimbursement Institute Webinar Nov. 10: MACRA Final Rule: Key Implications and Strategies for Success, presented by Bruce A. Johnson and Sidney Welch.

For More Information

For questions regarding this information, please contact one of the authors, a member of Polsinelli's Health Care practice, or your Polsinelli attorney.







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