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August 03, 2020

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New Demonstration Program Would Reward Clinicians for Accepting Risk in Medicare Advantage

CMS recently announced that it wants to launch a new demonstration program, the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration. If approved and adopted as a demonstration project, the MAQI Demonstration would waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians who participate sufficiently in qualifying risk programs of Medicare Advantage plans by making such programs qualify for the Advanced Alternative Payment Model (AAPM) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaced the prior Medicare reimbursement schedule with a new pay-for-performance program that’s focused on quality, value, and accountability.

Under the terms of MACRA, physicians currently participate in the CMS quality payment program either through MIPS, which adjusts Medicare payments based on combined performance on measures of quality, cost, improvement activities; and advancing care information; or through participation in AAPMs, which require physicians to take on risk for care of patients.

At present, there are very few payment models that qualify for AAPM treatment under MACRA, leaving many physicians subject to MIPS despite a willingness to take on risk. Only the following CMS models currently qualify for AAPM treatment:

Many Medicare Advantage (MA) plans, however, have been more innovative than traditional Medicare fee-for-service and have adopted risk based payment models with physicians and other providers. As such, participation in such  MA Plans advances the goal of moving to a value-based healthcare system. The MAQI Demonstration would give providers taking on risk for participation in MA Plans, credit for purposes of the quality payment program of traditional Medicare. This could potentially continue to spur the innovation seen in Medicare Advantage, especially when coupled with the changes made to plan development and supplemental benefit structures in the 2019 Medicare Advantage Call Letter and 2018 Bipartisan Budget Act.

CMS seeks public comment on the information collection burdens associated with the MAQI Demonstration, which is under consideration for formal approval. Comments must be received by September 4, 2018.

© 2020 Foley & Lardner LLPNational Law Review, Volume VIII, Number 193


About this Author

Alexis Bortniker, Health Care Attorney, Foley Lardner Law Firm

Alexis Bortniker is a senior counsel and health care lawyer with Foley & Lardner LLP. Her practice focuses on transactional and regulatory matters with an emphasis on counseling health systems, hospitals, and other providers in managed care and physician contracting. Ms. Bortniker is a member of the firm’s Health Care Industry Team.

Previously, Ms. Bortniker was an associate with Choate Hall & Stewart LLP where she gained experience working directly with health care organizations on regulatory and corporate compliance issues, including...

C. Frederick Geilfuss II, Health Care Attorney, Foley Lardner Law Firm

C. Frederick Geilfuss II is a partner and health care lawyer with Foley & Lardner LLP. Mr. Geilfuss counsels health systems, hospitals, medical clinics, rehabilitation agencies, nursing homes, and other health care providers on general operational concerns, regulatory and business matters. He has many years of experience in health care acquisitions, integrated delivery service issues, managed care contracting, defense of providers against government enforcement actions, finance, real estate, administrative and medical staff issues, physician recruitment, fraud and abuse matters, and other health law issues. He is a member of the firm’s Health Care Industry Team. Mr. Geilfuss is co-chair of the Health Care Industry Team Business and Transactions Work Group.