MACRA

MACRA, otherwise known as the Medicare Access and CHIP Reauthorization Act, is a law that was signed into office on April 16, 2015, by President Barack Obama. This act was introduced as a form of replacement for the Medicare current reimbursement schedule and offers several key benefits in the health care world, both for health care providers and for patients.

The new program was brought into action to offer a sort of “pay for great performance” and focuses on accountability and quality from health care professionals. MACRA rewards health care professionals for providing better quality care, rather than quantity of care. MACRA has two paths, the Merit-based Incentive Payment System and the Alternative Payment Models.

Physicians can select how they’d like to participate and which of the two paths they’d like to go down. Essential factors to consider when choosing which path to take is the specialty, practice location, and practice size.

Quality Payment Program

The Quality Payment Program is a program created by MACRA that does several things:

  •  reverses Sustainable Growth Rate formula
  • modifies rewards offered by Medicare for health care professionals for value rather than volumes
  • offers extra payments for the contribution in alternative payment models (APMS)
  • helps multiple programs in the Merit-Based Incentive Payments System run both smoothly and efficiently

Per MACRA, all Medicare cards should not contain patients’ Social Security numbers as of April 2019. The Quality Payment Program offers both innovation and adaptability of health care and the delivery of health care to Medicare beneficiaries. Because of this, Medicare patients will receive better quality care and much better outcomes. Health providers will also be rewarded for providing quality care.

Merit-Based Incentive Payment System (MIPS)

Medicare Electronic Health Record (EHR), Physician Quality Reporting System (PQRS), and Value-based Payment Modifier (VBM) all have aspects combined into a program called “MIPS” – Merit-based Incentive Payment System

MIPS helps ascertain payment modifications with Medicare. Health professionals may qualify to receive payment bonuses, penalties, or can even determine if there is no adjustment necessary. Scores for performance are based on the use of health records through technology, quality, and how health facilities are improving. MIPS scores are incredibly important as these can drastically affect providers’ Medicare payment reimbursements.

Advanced Alternative Payment Models

An APM (Alternative Payment Model) that recompenses health care providers for upstanding quality and cost-effective health care. Advanced APMs allow health care facilities to obtain more rewards for taking larger patient-related risks. Advanced Alternative Payment Models and APM will be accessible to qualified health care providers who have commendatory ratings.

New Cards for Patients

Per CMS, MACRA has enforced the removal of all Social Security Numbers from Medicare cards for all Medicare beneficiaries. By doing this, financial and health care information is kept private. Federal health benefits and all service payments are also protected in doing this.

MACRA and it’s Impact on Medicare Beneficiaries

MACRA can be an incredibly beneficial act in place for health care providers but can be equally as helpful for Medicare beneficiaries. With increased options in receiving bonus payments, physicians will be providing their patients with a higher quality of care. Increased positive patient outcomes are considered an overall win.

MACRA Impacts on Healthcare Providers

MACRA is a useful program to form new and creative ways in which to pay its health care providers. With high-quality care being provided by health professionals, an increase in reimbursement can be seen. MACRA will start changing physicians’ payments in 2021. Physicians can expect to see pricing changes from –7 percent to 7 percent.

Recap

The Medicare Access and CHIP Reauthorization Act was signed into law as a form of incentive and opportunity for providers. MACRA is also a source of quality-management for patients throughout the United States. Holding health care providers accountable for the quality of work they put into their practices can create a chain-link of positive events and fantastic outcomes for Medicare patients.

MACRA also helps ensure patient and provider privacy with modifications made to Medicare cards regarding patient information, as well as health care practice privacy. Physicians have two payment model routes (APMs and MIPS) in which they can take depending on what their practice size, locality, and specialty is.

Medicare tries to ensure excellent customer satisfaction, and MACRA is just another form in which to accomplish this common goal. Medicare also wants to help set health care physicians and practices up for success. By equipping them with the know-how to ensure quick turn-around times and quality one on one care with their patients.

We’ve all heard the saying “quality over quantity,” and that’s precisely what this law ensures. Physicians can expect to begin seeing changes to pricing in 2021.

How Minnesota, Massachusetts and Wisconsin Plan to Comply with MACRA in 2020

Insurance regulators in Massachusetts, Minnesota, and Wisconsin currently manage their own Medigap programs. Using the same state rules for over 2 decades.

New MACRA minimum deductible requirements change the way each state operates the Medicare program.

Regulators in these states must comply with new changes even though policies options aren’t the same.

Today’s requirements are likely to conflict with any previous state rules’ from almost 30 years ago.

How First Dollar Coverage Plan in Minnesota, Massachusetts and Wisconsin Will Be Impacted Come 2020

Massachusetts, Minnesota, and Wisconsin obtained waivers

Massachusetts, Minnesota, and Wisconsin obtained waivers from implementing the standardized Medicare Supplement plans because these states already had statewide standardized plans prior to 1990.

These waivered states must comply with eliminating coverage for the Part B deductible.

Below, we’ll breakdown what we know so far regarding how these states plan to comply with MACRA by 2020.

How these States Plan to Comply with MACRA by 2020

Minnesota

There are two Medicare Supplement plans available in Minnesota known as basic & extended basic with optional riders.

Any policies sold to new enrollees on or after January 1, 2020, will no longer be able to provide coverage for the Medicare Part B annual deductible.

People who are eligible for Medicare before January 1, 2020, will be able to purchase a policy that covers the Medicare Part B deductible.

We’ve reached out to the Minnesota DOI multiple times to see how they plan to comply with MACRA, but have not received a response. Once any information is released by the DOI, it will be published to their online bulletins.

Massachusetts

There are two Medicare Supplement plans offered in Massachusetts known as the Core Plan & Supplement1.

The Massachusetts Division of Insurance recently annonced there will be a new 1A Plan introduced in 2020.

It will be offered to benefiaries who are not eligible for Medicare until after 12/31/2019.

This policy will work very similiar to the standard Plan G.

You’ll have to meet the Part B deductible before you receive 100% coverage for your medical costs.

Wisconsin

Wisconsin offers a basic benefit plan with up to 7 additional benefit riders.

There was a hearing on May 10, 2019, to propose changes.

The proposed rule implements changes to Medicare Supplement benefits that are permitted to be offered after January 1, 2020.

Policies issued to individuals that are first eligible for Medicare benefits on or after January 1, 2020, may not contain the option to purchase a Part B deductible rider.

You can follow the status of the proposed rule on oci.wi.gov.

How these MACRA Changes Impact the Above States Medicare Beneficiaries

The 2020 MACRA changes shouldn’t impact the above states Medicare beneficiaries significantly. The only difference is beneficiaries that are not eligible for Medicare until January 1st, 2020 will now be responsible for the Medicare Part B deductible. As of 2020, the Part B deductible is $198.

2 Comments

  1. Some plans give you Eye exam coverage, Dental coverage and even a gym plan. But we want 100% coverage no deductible, no out of pocket so when we go to this plan we pay more but loose any Dental or Eye coverage! Why?

    • Hi Joyce! There is no all-in-one plan that will have no out of pocket costs. That’s why commercials for Medicare Advantage plans are very misleading. Yes, they include some coverage for dental, vision, and hearing, but the benefits are very limited and you have high out of pocket costs so you can have zero dollar deductibles. If you want 100% coverage with no out of pocket costs, you’re going to have to combine a few plans together. You would need Part A, Part B, Part D, & a Medigap plan. You would also want to pick up a stand-alone dental, vision, & hearing plan. You pay more in premiums because you have no out of pocket costs. If you want lower premiums, you’ll have more out of pocket costs.

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