MEDICARE ADVANTAGE QUALIFYING PAYMENT ARRANGEMENT INCENTIVE DEMONSTRATION PROJECT

            The Centers for Medicare and Medicaid Services (CMS) recently posted a fact sheet and Frequently Asked Questions related to the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration.  Under the MAQI Demonstration, eligible clinicians “who participate to a sufficient degree in certain payment arrangements with Medicare Advantage Organizations (combined with participation, if any, in Advanced Alternative Payment Models with Medicare Fee-for-Service)” will be excluded from the Merit-Based Incentive Payment System (MIPS) reporting requirements and payment adjustments. The goals of the MAQI Demonstration are to determine whether exempting clinicians from the MIPS reporting requirements will increase or maintain eligible clinician participation in payment arrangements with Medicate Advantage Organizations that are similar to Advanced APMs, to determine whether the exemptions change how clinicians deliver care, and to determine whether any changes in utilization affect Medicare Advantage plan bids.

            The CMS fact sheet and Frequently Asked Questions detail who is considered an “eligible clinician” for participation in the MAQI Demonstration, the definition of which has been revised to add such providers as physical therapists and clinical psychologists for the 2021 MIPS payment year.  The fact sheet and Frequently Asked Questions also provide information on the thresholds necessary to qualify for the reporting exclusions under the MAQI Demonstration.  The Demonstration is scheduled to last five years.

            The CMS fact sheet and Frequently Asked Questions are linked here and here, respectively.