2018 Bipartisan Budget Act brings big changes to MIPS/MACRA

Category: Bipartisan Budget Act, Congress, Children’s Health Insurance Program, MIPS, MACRA

2018 Bipartisan Budget Act brings big changes to MIPS/MACRA


Tucked away in the Bipartisan Budget Act,  Congress rolled out several changes with potentially big impact on physicians and providers.

The bill contains an extension for CHIP funding, reforms to the treatment of chronic health conditions, and extension of temporary payments for rural services providers. Additionally, the bill also includes several key provisions that will affect reimbursement to providers, including changes to the Merit-Based Incentive Payment System (MIPS).

“Technical Changes” to MIPS

The legislation’s major changes to  MIPS characterized as “technical changes” are:

  1.  extending the MIPS transition period through 2021;
  2. granting a reduction in the “cost” category of MIPS from the mandatory 30 percent threshold in 2019 to a 10 percent to 30 percent discretionary range through 2021;
  3. a gradual implementation of the performance threshold by modifying it from an average score in 2019 to a gradually increasing point value in 2021, which is anticipated to reduce the number of providers receiving a penalty;
  4. reduction of the base physician fee schedule (MPFS) update to .25 percent; and perhaps most significantly,
  5. limiting the MIPS payment adjustment's application to costs for clinician services and prohibiting its application to separately-billed items, like Part B-covered drugs and biologics.

These “technical changes” are potentially significant reforms.

Changes related to Part B claims for items could have sizeable financial ramifications for providers whose charges for separately billed items are much higher than the total charges for in-office services. 

These changes also remove separately billed items Part B claims from the low-volume Part B threshold calculation which means that more providers will likely be excluded from the program.

This change was welcomed by the American College of Rheumatology, American Society of Clinical Oncology, and American Urological Association, who had previously written to Congress to try to invoke this change in legislation: “If left as-is, this policy will negatively impact patients’ access to critical life and sight-saving treatments by putting specialties that provide high-cost drugs at risk. It will significantly amplify the range of bonuses and penalties intended by MACRA, only for certain specialties.”

 Additional Policies affecting Claim Reimbursement

The legislation also contained several miscellaneous provisions that will impact providers, regardless of their geographic or demographic practices including:

  1. repeal of Medicare reimbursement cap for therapy services starting on January 1, 2018;
  2. five-year extension of the 2 percent urban, 3 percent rural, and 22.6 percent super rural ground ambulance add-on payments;
  3. extension of Medicare low-volume hospital payment program until October 1, 2019;
  4. five-year extension of Medicare-Dependent Hospital program;
  5. requirements that HHS  reform the home health payment system by implementing a 30-day episode for payment by January 1, 2020; and
  6. two-year extension of blended site neutral payment rate for certain long-term care hospital discharges.

Healthcare providers will begin to see changes in reimbursement and revenues as a result of these changes and can likely expect to see more changes to MIPS/MACRA with the 2019 budget bill proposals. 

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