CMS Suggests Demonstration to Waive MIPS Rules for Clinicians

The Centers for Medicare and Medicaid Services (CMS) wants to roll out a demonstration to test the concept of waiving Merit-Based Incentive Payment System (MIPS) mandates for clinicians who participate in certain Medicare Advantage plans that involve assuming risk, reports Health Data Management . The Quality Payment Program (QPP) established by the Medicare Access and CHIP Reauthorization Act stipulates that clinicians currently participate in the QPP either via MIPS, which adjusts Medicare payments based on combined performance on measures of quality, cost, improvement activities, and advancing care information; or via Advanced Alternate Payment Models (APMs), which requires clinicians to assume risk for what is spent for their beneficiaries' healthcare. CMS says certain Medicare Advantage plans are developing innovative arrangements that resemble Advanced APMs, but without undertaking the agency's proposed Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration, doctors are still subject to MIPS even if they participate extensively in such arrangements. "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," says 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."