A central structural update is the official sunset of the traditional Merit-based Incentive Payment System reporting option, concluding more than a decade of MACRA implementation. CMS finalized that traditional MIPS reporting will terminate beginning with the CY 2031 performance period, granting clinicians through the CY 2030 performance year to fully transition into MIPS Value Pathways or qualifying Advanced Alternative Payment Models. This schedule provides two additional transition years compared to the initial proposed rule.

To facilitate migration into pathways that already cover roughly ninety-eight percent of clinicians, the final rule introduces three new specialized MVPs focused on diabetes, hypertension, and hospitalist care. Furthermore, beginning in the CY 2027 performance period, clinicians participating in MVPs will be required to report at least one specialty-specific Core Measure. In parallel, the rule establishes two new dedicated billing codes for Advance Care Planning and formally codifies noncitizen Medicare eligibility standards enacted under the Working Families Tax Cuts legislation.

Building on the sustained financial and clinical performance of the Medicare Shared Savings Program—which generated savings for the Medicare Trust Funds for eight consecutive years, including $4.1 billion in earned shared savings across seventy-five percent of participating ACOs in performance year 2024—the rule introduces major operational enhancements.

Beginning April 1, 2027, approved ACOs will be authorized to reduce or entirely eliminate Part B cost-sharing for many items and services for assigned beneficiaries, directly lowering out-of-pocket expenses to promote early intervention and preventive visits. To expand program participation, CMS increased shared savings rates for eligible ACOs, established financial incentives for first-time entrants, and instituted more predictable spending targets.

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