In Major Legislative Win, Congress Passes Legislation that Includes a CR, Two-Year Budget Deal, IPAB Repeal, and ASCRS-Requested Technical Changes to MACRA Law

Early this morning, years of advocacy by ASCRS, the Alliance of Specialty Medicine, and the medical community have paid off in the form of IPAB repeal and much-needed technical changes to MACRA.

Shortly after a second government shutdown had begun, Congress passed a legislative package, titled the Bipartisan Budget Act of 2018, that includes a Continuing Resolution (CR) that will fund the government through March 23, a two-year budget deal, and the healthcare extenders package including ASCRS-requested technical corrections to the Medicare Access and CHIP Reauthorization Act (MACRA) and repeal of the Independent Payment Advisory Board (IPAB), another top ASCRS legislative priority and one for which we have advocated for several years. After the Senate passed its version by a vote of 71-28, the House voted 240-186 to approve the package.

Also included in the final bill, as part of the offsets for Medicare and other healthcare extenders—and in lieu of the extension of the misvalued code provision included earlier this week in the House-passed version of the CR—is a reduction in the MACRA update for 2019. That update will now be 0.25% rather than the originally scheduled 0.5%. The CR gives Congress until midnight March 23 to pass an omnibus spending bill for the remaining six months of FY 2018.

Passage of this legislation is a major advocacy win for ASCRS and the entire medical community, as it includes key technical changes to the MACRA statute to help clinicians successfully participate in the Merit-Based Incentive Payment System (MIPS). This pathway is essential for ASCRS members as there are no ophthalmology specific Alternative Payment Models (APMs) available at this time. The technical changes, for which ASCRS and the medical community have advocated during the past year, include:

  • Giving CMS the authority to extend the MIPS transition period for an additional three years before having to set the MIPS performance threshold at the mean or median of the previous year’s score
  • Continuing to weigh the Cost category at less than 30% for three additional years
  • Excluding Medicare Part B drugs from MIPS eligibility determinations and payment adjustments

Additionally, the bill includes the repeal of IPAB and its authorities and powers as established in the Affordable Care Act (ACA). ASCRS has lobbied for IPAB repeal since its inception, and hundreds of ASCRS and ASOA members got involved in our advocacy efforts by responding to our grassroots alerts and contacting their members of Congress. As a result of that advocacy, the House voted to repeal IPAB last November, and our continued pressure has resulted in final passage.

The week began with the House passing its own version of the CR, to which we alerted our members. The House version funded the government through March 23 and included the MACRA technical corrections and a one-year extension of the misvalued code provision. On Wednesday, Senate Majority Leader Mitch McConnell (R-KY) and Minority Leader Charles Schumer (D-NY) reached an agreement on the two-year budget deal to be included in legislation with the CR.

After clearing both chambers, the bill was sent to President Trump, who signed it this morning.

We will keep you updated on issues related to the passage of this legislation.