Budget Act Includes Changes to MIPS

Feb 13, 2018

The recently enacted legislation to fund the government for the next two years – the Bipartisan Budget Act of 2018 – includes changes to the Merit-based Incentive Payment System (MIPS), Medicare’s physician payment program established by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.  The modifications respond to concerns raised by stakeholders including ASRA and others about the program and include:

  • Transition in impact of cost performance on the MIPS total performance score: For 2018 (affecting payments in 2020), cost performance represents 10 percent of a physician’s MIPS total performance score.  The Bipartisan Budget Act of 2018 gives the Centers for Medicare and Medicaid Services (CMS) discretion in determining the weight of cost performance on a physician's MIPS total performance score from 2018 – 2021 (affecting payments in 2020 – 2023) to represent no less than 10 percent and no more than 30 percent of the score.  Additionally, physicians will only be assessed on performance relative to their peers – and not improvement as the original MACRA law required – for these years.  Finally, CMS must annually report activity on its website relate to the development of new cost measures for MIPS assessment. 
  • More gradual transition of MIPS performance threshold: The Bipartisan Budget Act of 2018 establishes a more gradual and incremental transition to full implementation of MIPS for years two through five of the program.  In particular, the Bipartisan Budget Act of 2018 gives CMS discretion to establish a minimum performance threshold to help physicians fully adapt to the new value-based payment program.
  • Elimination of MIPS payment adjustment impact on physician-administered drug reimbursement: In response to concerns raised by specialty doctors that administer drugs to Medicare beneficiaries in their offices, the Bipartisan Budget Act of 2018 eliminates MACRA’s requirement that the MIPS payment adjustments impact not only physician services, but also the items they provide.  As a result, Medicare reimbursement for physician-administered drugs will not reflect the individual physician’s MIPS payment adjustment. 

 For more information on MIPS, see ASRA's fact sheets:

Read more about ASRA's advocacy efforts.

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