CMS testing Medicare Advantage as an Advanced APM

July 11, 2018
Medicare Web

CMS could grant providers in certain Medicare Advantage plans another pathway to participate in an Advanced Alternative Payment Model (Advanced APM) and be exempt from Merit-based Incentive Payment System (MIPS) requirements.

The agency outlined plans to advance the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration in a June 29 press release. MAQI would waive MIPS requirements for providers that participate in Medicare Advantage plans that involve taking on risk.

Providers who participate in an Advanced APM take on financial risk and financial incentives for their patients’ healthcare outcomes. However, these providers do not have to report MIPS quality data and their payments are not adjusted based on that data.

Some Medicare Advantage plans are developing arrangements that are similar to Advanced APMs, according to CMS. Providers participating in these arrangements are still subject to MIPS. CMS is opening the MAQI demonstration to test whether waiving MIPS for these providers will encourage more providers to participate in risk-sharing Medicare Advantage plans.

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