CMS Pushes Demo Waiver of MIPS Requirements

Federal regulators say a demonstration waiver is needed because physicians would otherwise be subject to MIPS, even if they participate in Advanced APM models under Medicare Advantage.

The Centers for Medicare & Medicaid Services is proposing a demonstration project that would waive Merit-Based Incentive Payment System requirements for clinicians who join some risk-bearing Medicare Advantage plans.

CMS Administrator Seema Verma said in a media release that the Medicare Advantage Qualifying Payment Arrangement Incentive 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."

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) gives physicians two payment tracks under fee-for-service Medicare: MIPS, which requires clinicians to report quality data to CMS and have their payment adjusted; and Advanced Alternative Payment Models, which require clinicians to take on risk.

Some Medicare Advantage plans are developing arrangements that resemble Advanced APMs. Without the demonstration, however, physicians would still be subject to MIPS, even if they participate extensively in Advanced APM-like arrangements under Medicare Advantage.

"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," Verma said.