Medicare Access and CHIP Reauthorization Act (MACRA) of 2015

InsightsClient Alert

The Medicare Access and CHIP Reauthorization Act (MACRA), which was signed into law on April 16, 2015, repealed the Sustainable Growth Rate (SGR) formula related to Medicare physician payments. Physician payments will progress to a new system that rewards physicians based on value and improving quality of care and away from a volume-driven system. The following are major provisions of MACRA impacting non-physician services:

Sec. 202. Extension of therapy cap exceptions process. Extends the therapy cap exceptions process until January 1, 2018, and reforms the process of medical manual review to help support the integrity of the Medicare program.

Sec. 203. Extension of ambulance add-ons. Extends the add-on payment for ground ambulance services, including in super-rural areas until January 1, 2018.

Sec. 204. Extension of increased inpatient hospital payment adjustment for certain low-volume hospitals. This provision extends special add-on payments until October 1, 2017.

Sec. 205. Extension of the Medicare-dependent hospital (MDH) program. This provision extends special payments to MDHs until October 1, 2017.

Sec. 210. Medicare Home Health Rural Add-On. This policy extends a three percent add-on to payments made for home health services provided to patients in rural areas through January 1, 2018.

Sec. 301. 2-Year Extension of the CHIP. This provision preserves and extends CHIP, funding the program through fiscal year 2017.

Sec. 412. Medicaid DSH. Reductions in state DSH allotments were scheduled to begin in fiscal year 2017. This policy delayed Medicaid DSH cuts until fiscal year 2018 and added another year of DSH cuts in 2025.

Sec. 521. Delay of two-midnights. This provision allows CMS to continue use of the Medicare Administrative Contractor (MAC) “probe and educate” program on a pre- payment basis, through September 30, 2015.

If you have any questions, please contact our Albany office at (229) 883-7878 or our Atlanta office at (404) 220-8494.