How Will MACRA Impact Stage 3 Meaningful Use?

MACRALast week CMS and ONC released the long awaited Final Rules modifying stage 2 meaningful use requirements and laying out the criteria for stage 3. Both final rules simplify requirements and add new flexibility for providers participating in the EHR Incentive program. With the unveiling of the final rules, CMS also announced a 60-day public comment period to gather more feedback about the EHR Incentive Programs going forward, and in particular with respect to the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA.

Passed in April during HIMSS15, MACRA repeals the Sustainable Growth Rate (SGR) program and establishes the Merit-based Incentive Payment System (MIPS).  The MIPS program consolidates certain aspects of a number of quality measurement and federal incentive programs into one efficient framework including VBM, PQRS and, of course, meaningful use.  CMS says it will use comments and feedback received to drive future policies for the EHR Incentive Program as well as for rulemaking to implement MACRA. CMS says it expects to release MACRA in spring 2016.

Here’s a timeline recap leading up to last week’s final rules and synopsis.

  • March 30, 2015: CMS issues a Notice of Proposed Rulemaking (NPRM) for Stage 3 proposed rule.
  • April 9, 2015: CMS issues an NPRM for Modifications to Stage 2 Meaningful Use (2015 through 2017).
  • April 16, 2015:  The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is enacted after publication of the proposed EHR rule. Part of MACRA sunsets the meaningful use payment adjustment for eligible professionals by end of 2018. MACRA establishes the Merit-Based Incentive Payment System (MIPS) which incorporates meaningful use.

Here are two passages from the final rule explaining MACRA’s impact on future rulemaking and meaningful use:

[content_box type=”without-header” text_color=”dark” color=”default”]
In light of the passage of MACRA, this final rule with comment period also allows for a 60-day public comment period on certain provisions noted in the “Supplementary Information” section above in part to support the transition to MIPS. The comments received during the comment period may be considered as we prepare for future rulemaking to implement MIPS, which in general is expected to be more broadly focused on quality and care delivery.[/content_box]

[content_box type=”without-header” text_color=”dark” color=”default”]
The enactment of MACRA has altered the EHR Incentive Programs such that the existing Medicare payment adjustment for EPs will end in CY 2018 and be incorporated under MIPS beginning in CY 2019. It is our intent to issue a notice of proposed rulemaking for MIPS by mid-2016. This final rule with comment period synchronizes reporting under the EHR Incentive Programs to end the separate stages of meaningful use, which we believe will prepare Medicare EPs for the transition to MIPS. In the Stage 3 and the EHR Incentive Program in 2015 through 2017 proposed rules, and in this final rule with comment period, we have responded to public input and comments by providing for flexibility that may assist EPs in preparing for the transition to MIPS. This final rule with comment period establishes a number of key final policies in response to these concerns: a simplification of program requirements, an introduction of flexibility within certain objectives, an option to participate in Stage 3 in 2017 but not required until 2018, and an overall focus on interoperability. We have focused on leveraging health IT to support providers and reduce burdensome requirements within an evolving environment.[/content_box]

Related links reading: