Bill
HR 8622
DPPS replaces MIPS with a data-driven payment system linking Medicare adjustments to a composite performance score, with budget neutrality and targeted small/practice incentives.
Purpose
- The bill aims to transform the current Merit-based Incentive Payment System (MIPS) into a Data-driven Performance Payment System (DPPS) within the Medicare physician fee schedule, starting January 1, 2027.
- It intends to modernize how performance-based payments are calculated and adjusted for physicians under Medicare, with an emphasis on data-driven methods and new incentive structures.
Key Provisions
1) Establishment and name transition
- Creates the Data-driven Performance Payment System (DPPS) as the successor to MIPS, integrated into the Medicare payment system under section 1848(q) of the Social Security Act.
- References to MIPS or the DPPS in law would be updated to reflect DPPS, with a transition period to avoid provider confusion. During the transition, references to DPPS would be treated as including MIPS.
2) Transition and terminology
- The Secretary of Health and Human Services must manage a transition plan to minimize confusion between old and new terms.
- Until the transition is complete, references to DPPS may be treated as including MIPS, and vice versa.
3) Adjustments and performance factors (DPPS mechanics)
- Changes to how adjustment factors are determined for DPPS:
- For years before 2028, certain adjustment-factor calculations are modified to gradually shift toward the new DPPS framework.
- Starting in 2028 and beyond, DPPS-adjustment factors for each eligible professional will be based on a composite performance score relative to a year-specific performance threshold, with tiered multipliers:
- If above the threshold: 1.25 multiplier
- If exactly at the threshold: 1.0
- If below the threshold: 0.75
- If treated as the lowest possible score for a given measure: 0.5
- The Executive details include restructured subclauses and subparagraphs to implement these adjustments, along with transitions for 2028+.
4) Performance thresholds and future years
- The bill adds a temporary extension framework for performance thresholds through 2033 (and potentially beyond), with a cap that thresholds cannot exceed 75 points.
- Allows for flexibility to extend or transition thresholds in response to extraordinary circumstances (natural disasters, public health emergencies, cybersecurity incidents).
5) Budget neutrality and financial controls
- For 2028 and subsequent years, DPPS adjustment factors must be calibrated to ensure that changes in payments remain budget-neutral. If high-performing professionals receive increases, corresponding reductions must be applied to those below the threshold, so overall net charges do not exceed targeted levels.
- A new budget-neutrality clause specifies how to balance increased payments with reductions to keep total aggregate charges within planned levels.
6) Under-resourced practices investment
- Introduces a new optional incentive mechanism to support under-resourced practices, especially small practices (defined as 15 or fewer professionals) and those in rural or underserved areas.
- If a DPPS savings year occurs and the practitioner meets criteria, eligible professionals can receive a lump-sum incentive payment funded from the DPPS savings year allocation.
- The incentive aims to promote care management improvements, address health-related social needs, advance EHR/certified EHR implementation, and participation in value-based care models.
- Criteria include attestation of participation in a small practice and eligibility for priority funding for certain small practices (e.g., rural, Health Professional Shortage Areas, medically underserved areas, or low composite scores).
7) Data reporting, feedback, and timely information
- Requires timely feedback to DPPS-eligible professionals (defined as quarterly feedback within 60 days after the end of each quarter) on performance measures, including administrative claims-based measures.
- Feedback must include patient/episode descriptions, items and services contributing to performance, and whether services were provided by the professional or others in a group setting.
8) Additional definitional and compliance adjustments
- Minor conforming amendments to existing statutory language, including adjustments to references and cross-references with other parts of the Social Security Act.
- Adds targeted provisions to ensure compatibility with other incentive payment provisions and to prevent double counting or unintended interactions with other payment programs (e.g., 1833).
Who Is Affected
Timeline and Procedural Notes
Overall Impact
Compiled from official sources — confirm details with the bill’s official record.
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