On April 16, 2015, the President signed into law H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In part, the bill:
- Eliminates the Sustainable Growth Rate (SGR) formula under the Medicare Physician Fee Schedule and replaces it with five years of 0.5% updates, then transitions practitioners to a system that emphasizes participation in alternate payment models such as accountable care organizations (ACOs) or value-based payment
- Extends and supplements Children's Health Insurance Program (CHIP) funding for two years
- Extends several rural-relevant payment provisions for two years, including rural add-on payments for ambulance services and home health, payments for low volume hospitals, Medicare dependent hospital payments, the work Geographic Practice Cost Index (GPCI) floor and exceptions to the therapy caps
- Delays Medicaid Disproportionate Share Hospital (DSH) payment cuts one year, until fiscal year (FY) 2018, and extends them to FY 2025
- Delays the two-midnight hospital inpatient admission policy until September 30, 2015
- Delays and phases in over six years a 3.2% hospital inpatient payment increase scheduled for FY 2018
- Authorizes and extends funding through FY 2017 for the Health Resources and Services Administration's (HRSA) Health Centers; the National Health Service Corps (NHSC); and the Maternal, Infant and Early Childhood Home Visiting, Teaching Health Center Graduate Medical Education and Family-to-Family Health Information Center programs
- Prohibits Medigap plans from covering the Part B deductible for new Medicare enrollees beginning in 2020
- Increases the share of Part B and D premiums that higher income beneficiaries must pay
- Scraps the Centers for Medicare & Medicaid Services (CMS) proposal to eliminate 10- and 90-day global surgical payments in 2017 and 2018 in favor of data collection to reprice the payments accurately
