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News & Press: Legislative News

New Medicare Quality Payment Program Eligible Clinicians 2019

Tuesday, July 24, 2018  
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Legislative Update and Webinar: New Medicare Quality Payment Program Eligible Clinicians 2019

On July 12, 2018, CMS released a notice of proposed rule-making (NPRM) detailing proposed changes to Medicare's Quality Payment Program (QPP), including the expansion of eligible clinician types to include occupational therapists, physical therapists, clinical social workers, and clinical psychologists for the 2019 performance year.

Sign Up for the Webinar
The CMS Regional Office has scheduled a webinar specifically targeted to occupational therapists, physical therapists, clinical social workers, and clinical psychologists for Tuesday, July 31, 2018 from 1:00 - 2:30 PM EDT. Click here to sign up for this important information session.

Public comments on the proposed rules are due no later than 5pm on September 10, 2018. You may submit electronic comments on this regulation at http://www.regulations.gov. Follow the "Submit a comment" instructions. In commenting, please refer to file code CMS-1693-P. 

The QPP was established by Congress in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. In addition to permanently eliminating the sustainable growth rate, it also sunset the previous reporting programs (Physician Quality Reporting System, the Value-Based Payment Modifier, and the Electronic Health Record Meaningful Use program for Medicare providers) and replaced it with the QPP. The QPP contains two tracks clinicians can choose to participate in: the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). The changes discussed here are with the MIPS program. Initially, the clinician types that were eligible for the first two years of participation (2017 and 2018) included physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.

Clinicians or groups who are eligible to participate in MIPS are scored based on their performance in four categories: quality, cost, improvement activities, and promoting interoperability. There are situations in which certain clinicians or groups can be "exempt" from certain parts of the program (e.g., promoting interoperability) and there is a broader exemption from the entire MIPS program if a clinician or a group meets certain criteria.


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