CMS Issues Proposed Rule to Increase Flexibility and Reduce Burden in the Second Year of MACRA’s Quality Payment Program

On June 20, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (CMS-5522-P) that would make changes to the second year requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program (QPP). In keeping with the flexibility offered during the 2017 transition year, the agency noted that it “wants to ensure that there is meaningful measurement and the opportunity for improved patient outcomes while minimizing burden, improving coordination of care for patients, and supporting a pathway to participation in Advanced Alternative Payment Models (’APMs’).”

The QPP, which ends the Sustainable Growth Rate (SGR) formula, has two value-based tracks for providers: (1) the Merit-based Incentive Payment System (MIPS) and (2) the Advanced APMs.

In supporting documentation accompanying the proposed rule, CMS acknowledged that the QPP represents a significant change in the way Medicare reimburses clinicians. For this reason, CMS intends to continue its slow implementation and to seek feedback from various stakeholders in order to streamline and reduce clinician burden. As of January 1, 2017, CMS reports it has engaged more than 100 stakeholder organizations and over 47,000 individuals to raise awareness, solicit feedback, and assist eligible clinicians in participation preparedness. CMS Administrator Seema Verma stated, “We’ve heard the concerns that too many quality programs, technology requirements, and measures get between the doctor and the patient. That’s why we’re taking a hard look at reducing burdens. By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork. CMS will continue to listen and take actionable steps towards alleviating burdens and improving health outcomes for all Americans that we serve.”

The proposed rule includes potential amendments to existing requirements, as well as the addition of new policies for providers. Following are highlights of the proposed rule:


  • Offers the Virtual Groups participation option
  • Increases the low-volume threshold, exempting more small practices and rural or health professional shortage area clinicians from MIPS participation
  • Continues allowing the use of the 2014 Edition Certified Electronic Health Record Technology (CEHRT), while encouraging the use of the 2015 Edition CEHRT
  • Adds bonus points in the scoring methodology for:

    • Caring for complex patients
    • Using 2015 Edition CEHRT exclusively
  • Incorporates MIPS performance improvement in scoring quality performance
  • Incorporates the option to use facility-based scoring for facility-based clinicians
  • Adds a new hardship exception for small practice clinicians under the Advancing Care Information performance category
  • Adds bonus points to the Final Score of small practice clinicians
  • Continues awarding small practices three (3) points for measures in the Quality performance category that does not meet data completeness requirements


  • Extends the revenue-based nominal amount standard (previously finalized through performance year 2018) for two additional years (through performance year 2020), allowing an APM to meet the financial risk criterion to quality as an Advanced APM if participants are required to bear total risk of at least eight percent (8%) of their Medicare A and B revenue
  • Changes the nominal amount standard for Medical Home Models, allowing a slow increase to the minimum required amount of total risk
  • Provides more detail regarding implementation of the All-Payer Combination Option (which allows clinicians to become qualifying APM participants through participation in Advanced APMs and Other Payer Advanced APMs; this option is available beginning in performance year 2019).
  • Provides more detail regarding assessment of clinicians in selected APMs under the APM scoring standard (this standard reduces burden for certain APM participants who do not quality as qualifying participants and are therefore subject to MIPS)

Those interested in providing comments to the proposed rule must do so no later than 5 p.m. on August 21, 2017.

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