New Demonstration Program Would Reward Clinicians for Accepting Risk in Medicare Advantage

12 July 2018 Health Care Law Today Blog
Author(s): Alexis Finkelberg Bortniker C. Frederick Geilfuss II

CMS recently announced that it wants to launch a new demonstration program, the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration. If approved and adopted as a demonstration project, the MAQI Demonstration would waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians who participate sufficiently in qualifying risk programs of Medicare Advantage plans by making such programs qualify for the Advanced Alternative Payment Model (AAPM) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaced the prior Medicare reimbursement schedule with a new pay-for-performance program that’s focused on quality, value, and accountability.

Under the terms of MACRA, physicians currently participate in the CMS quality payment program either through MIPS, which adjusts Medicare payments based on combined performance on measures of quality, cost, improvement activities; and advancing care information; or through participation in AAPMs, which require physicians to take on risk for care of patients.

At present, there are very few payment models that qualify for AAPM treatment under MACRA, leaving many physicians subject to MIPS despite a willingness to take on risk. Only the following CMS models currently qualify for AAPM treatment:

Many Medicare Advantage (MA) plans, however, have been more innovative than traditional Medicare fee-for-service and have adopted risk based payment models with physicians and other providers. As such, participation in such  MA Plans advances the goal of moving to a value-based healthcare system. The MAQI Demonstration would give providers taking on risk for participation in MA Plans, credit for purposes of the quality payment program of traditional Medicare. This could potentially continue to spur the innovation seen in Medicare Advantage, especially when coupled with the changes made to plan development and supplemental benefit structures in the 2019 Medicare Advantage Call Letter and 2018 Bipartisan Budget Act.

CMS seeks public comment on the information collection burdens associated with the MAQI Demonstration, which is under consideration for formal approval. Comments must be received by September 4, 2018.

For more information on Foley’s Health Care Industry Team including the team, publications, and other materials, visit

This blog is made available by Foley & Lardner LLP (“Foley” or “the Firm”) for informational purposes only. It is not meant to convey the Firm’s legal position on behalf of any client, nor is it intended to convey specific legal advice. Any opinions expressed in this article do not necessarily reflect the views of Foley & Lardner LLP, its partners, or its clients. Accordingly, do not act upon this information without seeking counsel from a licensed attorney. This blog is not intended to create, and receipt of it does not constitute, an attorney-client relationship. Communicating with Foley through this website by email, blog post, or otherwise, does not create an attorney-client relationship for any legal matter. Therefore, any communication or material you transmit to Foley through this blog, whether by email, blog post or any other manner, will not be treated as confidential or proprietary. The information on this blog is published “AS IS” and is not guaranteed to be complete, accurate, and or up-to-date. Foley makes no representations or warranties of any kind, express or implied, as to the operation or content of the site. Foley expressly disclaims all other guarantees, warranties, conditions and representations of any kind, either express or implied, whether arising under any statute, law, commercial use or otherwise, including implied warranties of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Foley or any of its partners, officers, employees, agents or affiliates be liable, directly or indirectly, under any theory of law (contract, tort, negligence or otherwise), to you or anyone else, for any claims, losses or damages, direct, indirect special, incidental, punitive or consequential, resulting from or occasioned by the creation, use of or reliance on this site (including information and other content) or any third party websites or the information, resources or material accessed through any such websites. In some jurisdictions, the contents of this blog may be considered Attorney Advertising. If applicable, please note that prior results do not guarantee a similar outcome. Photographs are for dramatization purposes only and may include models. Likenesses do not necessarily imply current client, partnership or employee status.

Related Services