The White House Office of Management and Budget (OMB) is now reviewing a highly-anticipated Centers for Medicare & Medicaid Services’ (CMS) proposed rule to implement major Medicare physician payment reform provisions included in the Medicare Access and CHIP Reauthorization Act (MACRA).  As previously reported, MACRA repealed the Medicare sustainable growth rate (SGR) formula and directed the Secretary to implement reforms to tie physician payment updates to quality, value, and participation in alternative payment/delivery models.  Specifically, MACRA mandates the development of the Merit-based Incentive Payment System (MIPS) to replace existing physician quality programs (the Physician Quality Reporting System, the Value-Based Modifier, and the Electronic Health Records Incentive Program) beginning January 1, 2019.  Under MACRA, the MIPS quality measure list must be released by November 1, 2016.   MACRA also mandates incentives for providers to participate in alternative payment models (APMs) that focus on coordinating care, improving quality, and reducing costs; the Secretary must establish criteria for physician-focused APMs, including models for specialist physicians, by November 1, 2016.  While the text of the proposed rule is not available yet, the regulation appears to be on track to be issued in advance of the annual Medicare physician fee schedule proposed rule.