Breaking Down the MACRA Proposed Rule

This post, penned by Thorn Run's Billy Wynne, Katie Pahner, and Devin Zatorski, originally appeared in Health Affairs Blog.

The mother ship has landed. On Wednesday, April 27, the Centers for Medicare and Medicaid Services (CMS) released the highly anticipated proposed rule that would establish key parameters for the new Quality Payment Program, a framework that includes the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). These policies were established by the latest, permanent ‘doc fix,’ the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

For additional background, please refer to recent Health Affairs Blog posts on MACRAMIPS, andAPMs, as well as a comprehensive brief on MACRA. This post briefly outlines the key elements of the proposed rule.

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Today on the Hill: Energy-Water Bill Stalls Over Iran Amendment; House to Vote on Fiduciary Rule Disapproval

Senators today will try to break a partisan impasse that has held up the Energy and Water Development spending bill (H.R. 2028) before leaving for a week-long recess. The controversy comes over an amendment submitted by Sen. Tom Cotton (R-AR) that would thwart a recently struck deal for the United States to purchase heavy water – a form of water used in the certain nuclear reactors – from Iran. While the purchase is unrelated to last year’s comprehensive nuclear agreement with Iran, Democrats have labeled Cotton’s proposal as a “poison pill” and the White House has said it would veto the spending bill if the Iran language were included.

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Today on the Hill: Energy Approps, Angel Investors, Tariff Revisions

The Senate is moving toward finishing an Energy and Water Development spending measure, with a cloture vote scheduled on a substitute amendment (#3801) to the legislative vehicle for the bill (H.R.2028). The underlying measure would provide $37.5 billion for the Energy Department, Army Corps of Engineers, parts of the Interior Department and other agencies. That’s $355 million more than was allocated in fiscal 2016 and $261 million more than Obama requested.

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Today on the Hill: Energy Appropriations in the Senate; 14 Noncontroversial Votes in the House

The Senate is set to resume consideration of a $37.5 billion fiscal 2017 appropriations bill that would fund the Energy Department and government water projects, including the operations of the Army Corps of Engineers. Majority Leader Mitch McConnell (R-KY) moved to wrap up debate on the measure, filing cloture yesterday on the substitute amendment and the underlying bill. The cloture vote on the substitute amendment is set for tomorrow unless an agreement is reached to move it earlier. The Senate has agreed to vote today on amendments related to wind energy (No. 3812), water management (No. 3805), and Army Corps of Engineers construction funds (No 3820). The underlying measure would provide $37.5 billion for the Energy Department, Army Corps of Engineers, parts of the Interior Department and other agencies. That’s $355 million more than was allocated in fiscal 2016 and $261 million more than President Barack Obama requested. A pilot nuclear waste storage facility would be authorized under the measure.

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Financial Services Report

Looking Ahead

Near Term

  • The House will consider a series of Financial Services related measures this week, including H. J. Res. 88, that would disapprove of the Department of Labor’s (DOL) recently finalized conflict of interest rule for financial advisers. Additionally, a bill to help startup companies enjoy greater access to angel investors (H.R. 4498), and another that would revise the process for cutting duties on imports of manufacturing resources (H.R. 4923) are scheduled to be voted on.
  • The Senate will bring its first appropriations bill to the floor this week as it considers and aims to complete work the Energy and Water Development spending bill (H.R. 2028) before hopefully moving on to the Commerce-Justice-Science funding bill. 

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This Week on the Hill: House Moves Against DOL Fiduciary Rule as Senate Continues Approps Work

Both chambers are in session this week, with the House looking to roll back the Labor Department’s recently finalized fiduciary rule and the Senate continuing its early work in the appropriations process. The latest fight between the lower chamber and the Administration comes over a new Department of Labor (DOL) regulation intended to ensure that retirement advisers are working in their clients’ best interest. Opponents of the rule argue that its requirements are overly burdensome and will limit consumer access to financial advice. The House will debate a joint resolution of disapproval (H.J. Res. 88) under Congressional Review Act procedures to prevent the rule from taking effect next year. House lawmakers also plan to consider measures expanding access to angel investors (H.R. 4498) and extending the District of Columbia’s school voucher program (H.R. 4901), the latter of which is a legacy of former Speaker of the House John Boehner (R-OH).  

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Health Policy Report

The Week in Review

After two weeks of negotiation, the Senate finally finished work on a reauthorization measure for the Federal Aviation Administration (FAA) last week, before moving on to a comprehensive energy bill and the first appropriations bill – Energy and Water Development – to reach the floor of either chamber. The House, meanwhile, spent a week considering measures to curb the Internal Revenue Service (IRS) in connection with the country’s annual tax-filing deadline.

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Financial Services Report

Our Take

Because of a quirk in the calendar, millions of Americans will be rushing to the Post Office today to file their taxes.  Without getting into a political discussion about whether our taxes are too high, or not high enough, it is worth noting that many defenders of the federal income tax often quote Supreme Court Justice Oliver Wendell Holmes, who famously said that taxes are the cost of living in a civilized society.   That quote comes from a 1927 case, Compania General de Tabacos de Filipinas v. Collector of Internal Revenue,  and the full quote is:

It is true, as indicated in the last cited case, that every exaction of money for an act is a discouragement to the extent of the payment required, but that which in its immediacy is a discouragement may be part of an encouragement when seen in its organic connection with the whole. Taxes are what we pay for civilized society, including the chance to insure. 

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This Week on the Hill: Senate to Finish FAA, Energy Bills Before Moving to Approps; House Works on IRS, Puerto Rico

With today marking the annual income-tax filing deadline, the House starts the week with a series of bills intended to reform the Internal Revenue Service (IRS). The four pieces of legislation would freeze IRS hiring until it certifies no IRS employee has a “seriously delinquent” tax debt (H.R. 1206), bar the rehiring of employees who were fired for misconduct (H.R. 3724), require IRS user fees to be deposited into the Treasury’s general fund (H.R. 4885), and finally, end all IRS bonuses until the agency develops a comprehensive customer service strategy (H.R. 4890). All four bills were advanced in a contentious House Ways and Means Committee hearing last week, and none are expected to be taken up in the Senate.

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Health Policy Report

The Week in Review
 
Last week both chambers were in session, with the House returning from recess to pass a trio of financial services bills and the Senate continuing to deliberate on legislation to reauthorize the Federal Aviation Administration (FAA).

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