Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

What is the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)?

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is bipartisan legislation passed into law on April 16, 2015 which changed how the federal government reimburses physicians for Medicare. MACRA ended the Sustainable Growth Rate formula, created the Quality Payment Program (QPP) and extended the Children’s Health Insurance Program (CHIP).

The QPP established two new value-based payment models for physicians: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM). Both programs focus on reimbursing providers based on the quality of care they provide rather than the volume of their services.

Why is the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) important in healthcare?

MACRA officialized a new framework for clinician reimbursement that rewards quality of care over high patient volume. This was a major step in the move towards value-based care for the U.S. — opposing the long-standing fee-for-service approach standard for most providers within the country.

The extension of CHIP is another major contribution of this legislation. CHIP helps to ensure that children and pregnant women across the U.S. who cannot afford private healthcare — but also fall too far above the federal poverty line to qualify for Medicaid — receive healthcare coverage.

MACRA also required providers to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019 for improved security purposes.

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