These adjusted outlier exclusions substantially improve reliability and are reflected in Table 60 of this proposed rule
The definition of a Part D rebatable drug includes drugs approved under a new drug application under section 505(c) of the Federal Food, Drug, and Cosmetic (FD&C) Act (that is, brand name drugs), generic drugs approved under section 505(j) of the FD&C Act that meet certain statutory criteria (that is, sole source generic drugs), and biologicals licensed under section 351 of the Public Health Service Act (PHS), including biosimilars
We finalized in the CY 2022 PFS final rule that for the CY 2023 and 2024 MIPS performance periods/2025 and 2026 MIPS payment years, a subgroup reporting measures and activities in an MVP will submit its affiliated group's data for the Promoting Interoperability performance category and in the scenario that a subgroup does not submit its affiliated group's data, the subgroup will receive a zero score for the Promoting Interoperability performance category (86 FR 65413 and 65414)
Our approach to engagement is outlined in the CY 2018 Quality Payment Program final rule (82 FR 53644 and 53645), the CY 2019 PFS final rule (83 FR 59767 through 59769), the CY 2022 PFS proposed rule (86 FR 39396 and 39397), and the CY 2024 PFS proposed rule (88 FR 52568 through 52576)
We are adding new paragraph (c)(3)(iv) to 425.512 to establish for performance year 2025 and subsequent performance years, if CMS determines the ACO meets the requirements of the Extreme and Uncontrollable Circumstances policy and the ACO reports the APP Plus quality measure set, meets the data completeness requirement, and receives a MIPS Quality performance category score, CMS will calculate the ACO's quality score as the higher of the ACO's health equity adjusted quality performance score or the equivalent of the 40th percentile MIPS Quality performance category score across all MIPS Quality performance category scores, excluding entities/providers eligible for facility-based scoring, for the relevant performance year
