Medical Subject Headings (MeSH): Medicare Access and CHIP

Medicare Access and CHIP Reauthorization Act (MACRA) is a law passed by the US Congress in 2015 to address issues related to the reimbursement of healthcare providers under the Medicare program. The law repealed the flawed Sustainable Growth Rate (SGR) formula and established the Quality Payment Program (QPP) to incentivize healthcare providers to focus on quality and value of care.

The QPP includes two tracks:

The Merit-Based Incentive Payment System (MIPS) which consolidates three existing programs: the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program.

Alternative Payment Models (APMs) which incentivize providers to take on financial risk in exchange for potential bonuses.

MACRA also extends funding for the Children’s Health Insurance Program (CHIP) for an additional four years. CHIP is a federal-state partnership program that provides health insurance coverage to children in families who earn too much to qualify for Medicaid, but not enough to afford private insurance.

The law aims to improve the quality of care for Medicare beneficiaries, reduce costs, and provide incentives for healthcare providers to participate in alternative payment models. Its implementation is being rolled out gradually, allowing providers time to adjust to the new requirements and allowing CMS to make changes to the program as needed.

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