Definition

MACRA (Medicare Access and CHIP Reauthorization Act of 2015)

Contributor(s): Kristen Lee

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is U.S. healthcare legislation that provides a new framework for reimbursing clinicians who successfully demonstrate value over volume.

The legislation went into effect April 16, 2015, with subsequent deadlines coming for various aspects of the law from the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS).

The "CHIP" in the MACRA acronym stands for the Children's Health Insurance Program, which MACRA extends funding for.

As of September 2016, MACRA applied only to individual physicians, not to hospitals and hospital-based health systems. Hospitals may be subject to the law in the future, however.

MACRA will modify and perhaps eventually replace the meaningful use stage 3 incentive program as the newer law steers organizations toward using electronic health record (EHR) data for value-based care.

MACRA makes three important changes to how Medicare pays providers:

  • The law repeals the Sustainable Growth Rate (SGR) Formula that determined Medicare payments for providers' services.
  • Participating providers will now be paid based on the quality and effectiveness of care given.
  • MACRA combines existing quality reporting programs into one new system.

These changes create the Quality Payment Program (QPP), which is meant to help the healthcare system move more quickly toward the goal of value-based care.

The QPP has two paths:

  1. Merit-based Incentive Payment System (MIPS): A new program that measures eligible professionals on quality, resource use, clinical practice improvement and meaningful use of certified EHR technology.
  2. Alternative payment models (APMs): APMs create new ways for healthcare providers to get paid for the care they provide to Medicare beneficiaries. Some examples of APMs include accountable care organizations (ACOs), patient-centered medical homes and bundled payment models.

The timeline for MACRA is as follows:

  • November 2016: The final rules will be published to implement certain requirements of MACRA.
  • 2019: MIPS and APM payment provisions will go into effect.
This was last updated in October 2016

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