Sharon Grace, Vice President of Public Relations
703.838.0033 ext. 393
June 1, 2017
AMGA Joins Provider Stakeholders in Urging Medicare Advantage to Count toward Advanced APM Status in 2019
Alexandria, VA –Yesterday, AMGA along with other provider associations representing physicians, hospitals, multispecialty medical group practices, academic medical centers, and nearly all existing accountable care organizations, provided the Centers for Medicare & Medicaid Services (CMS) with a regulatory pathway for providers to have their Medicare Advantage (MA) contracts considered as part of the threshold requirements to qualify as advanced Alternative Payment Models (APMs) participants under the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP).
“Congress provided a framework with MACRA to move toward a system that is based on value,” said Chester A. Speed, J.D., LL.M., AMGA’s vice president, public policy. “This proposal builds on that effort and illustrates the opportunity that CMS has to increase APM participation by recognizing how participating in qualified Medicare Advantage plans can help providers meet the challenging advanced APM eligibility requirements.”
Under MACRA, eligible professionals who meet minimum revenue thresholds coming from certain APMs or minimum numbers of beneficiaries in APMs are eligible for a 5% bonus payment. Under current regulations, however, CMS restricts this bonus to only Medicare fee-for-service (FFS) revenue and patients. MA plans that would otherwise qualify are precluded from consideration until the 2021 payment adjustment year. While the MACRA statute does not support the inclusion of revenue associated with an MA contract as part of the revenue thresholds test in 2019 and 2020, the law does not prevent CMS from considering MA enrollees under the number of beneficiaries test.
“Providers with risk-based Medicare Advantage contracts are meeting the requirements to qualify as advanced APMs, and they should be recognized for transitioning the health system to value sooner rather than later. We believe this proposal allows CMS to reward providers who are willing to take risk,” Speed added.
The letter is available on the AMGA website.
AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans. For more information, visit amga.org