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FMCC 2016 MACRA Plenary by Amy Mullins

The document summarizes the Medicare Access and CHIP Reauthorization Act (MACRA) which repeals the Sustainable Growth Rate formula and shifts Medicare payments to value-based and alternative payment models. MACRA establishes two payment tracks - the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). MIPS consolidates existing quality programs and provides payment incentives or penalties based on a performance score. APMs offer additional rewards for physicians meeting thresholds for payments or patients in eligible models.

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MACRA: Medicare's Shift to Value-based Delivery & Payment Models Presented by Amy Mullins, MD, CPE
Current State Over Utilization Volume over Value Silos of Care 2 Materials herein reflect public law 114-10 dated April 16, 2015 2 Fee for Service
Push Toward Value & Quality 3 • Medicare payments tied to quality or value by end of 2018 • Of those through alternative payment models (APMs) by end of 2016 • Private payer business through value-based arrangements by 202075% Materials herein reflect public law 114-10 dated April 16, 2015
Medicare Access & CHIP Reauthorization Act (MACRA) 4 “To repeal the Medicare SGR and strengthen Medicare access by improving physician payments…” PhotoCourtesyofAmyMullins,MD Materials herein reflect public law 114-10 dated April 16, 2015
What is MACRA? • Signed into law April 16, 2015 • Passed 392 to 37 in the House and 92 to 8 in the Senate 5 Materials herein reflect public law 114-10 dated April 16, 2015
What Does MACRA Do? • Repeals the Sustainable Growth Rate (SGR) • Extends Children’s Health Insurance Program (CHIP) funding for 2 years • Creates 2 payment tracks • Provides Annual Baseline Fee Schedule Updates 2016-2018 6 Materials herein reflect public law 114-10 dated April 16, 2015
MACRA Timeline 2016 2017 2018 2019 2020 2021 2022- 2024 2025 2026 Medicare Part B Baseline Payment Updates -.27% +0.5% +0.5% +0.5% 0% 0% 0% +0.25%* +0.75%** *Non-qualifying APM Conversion Factor **Qualifying APM Conversion Factor +0% 7 Materials herein reflect public law 114-10 dated April 16, 2015
Payment Models • Consolidates quality programs Merit-Based Incentive Payment System (MIPS) • Potential for bonus payment for participation Alternative Payment Model (APM) 8 Materials herein reflect public law 114-10 dated April 16, 2015
Merit-Based Incentive Payment System (MIPS) Materials herein reflect public law 114-10 dated April 16, 2015
MIPS Highlights Consolidates existing quality and value programs • To ease administrative burden Establishes a Performance Score • Adds a category for Clinical Practice Improvement Activities Opportunity for payment adjustments • Both positive and negative 10 Materials herein reflect public law 114-10 dated April 16, 2015
Consolidates Quality & Value Programs 11 • Physician Quality Reporting System • Value Based Payment Modifier • Meaningful Use MIPS MU VBPM PQRS Materials herein reflect public law 114-10 dated April 16, 2015
Establish Composite Performance Score 12 Quality Resource Use Clinical Practice Improvement Activities Meaningful Use Materials herein reflect public law 114-10 dated April 16, 2015
Clinical Practice Improvement Activities (CPIA) • Access • Population Management • Care Coordination • Beneficiary Engagement • Patient Safety • Participation in an Alternative Payment Model 13 Materials herein reflect public law 114-10 dated April 16, 2015
Weighting by Category 2019 2020 2021 Quality 50% 45% 30% Resource Use 10% 15% 30% EHR MU 25% 25% 25% CPIA1 15% 15% 15% 1 - “Certified” patient-centered medical home will receive the full 15 points for CPIA 14 Materials herein reflect public law 114-10 dated April 16, 2015
“Certified” Patient-Centered Medical Home (PCMH) 15 • Not defined in law • Joint Principles of PCMH • Functions of Comprehensive Primary Care (CPC) – Risk-Stratified Care Management – Access and Continuity – Planned Care for Chronic Conditions and Preventive Care – Patient and Caregiver Engagement – Care Coordination Across the Medical Neighborhood Materials herein reflect public law 114-10 dated April 16, 2015
Annual Performance Threshold • Established by Secretary years 1 and 2 • Mean or median of previous year’s MIPS scores • Below = negative payment adjustments • Above = positive payment adjustments 16 Materials herein reflect public law 114-10 dated April 16, 2015
Adjust Payments -4% -5% -7% -9% 4% 5% 7% 9% 2019 2020 2021 2022 onward “With respect to positive MIPS adjustment factors…the Secretary shall increase or decrease such adjustment factors by a scaling factor in order to ensure that the budget neutrality requirement …is met” 17 Materials herein reflect public law 114-10 dated April 16, 2015
Adjust Payments 18 -4% -5% -7% -9% 12% 15% 21% 27% 4% 5% 7% 9% 2019 2020 2021 2022 onward Adjustment to provider’s base rate of Medicare Part B payment Maximum Adjustments Materials herein reflect public law 114-10 dated April 16, 2015
Exemptions 19 • Year 1 Medicare • Eligible APMs with Bonus • Below low volume threshold • Federally Qualified Health Clinics and Rural Health Clinics Materials herein reflect public law 114-10 dated April 16, 2015
Adjustment Summary 20 Performance Score Payment Adjustment Lowest quartile = Maximum negative adjustment At threshold = No adjustment “Exceptional Performers” = Eligible for up to 10% positive adjustment “Exceptional Performers” has yet to be defined Materials herein reflect public law 114-10 dated April 16, 2015
MACRA Timeline 2016 2017 2018 2019 2020 2021 2022- 2024 2025 2026 Medicare Part B Baseline Payment Updates -.27% +0.5% +0.5% +0.5% 0% 0% 0% +0.25%* +0.75%** *Non-Qualifying APM Conversion Factor **Qualifying APM Conversion Factor Merit-Based Incentive Payment System (MIPS) PQRS, Value-based Modifier, & Meaningful Use Quality, Resource Use, Meaningful Use, & Clinical Practice Improvement Activities -6% -9% -9%? +/-4% +/-5% +/-7% +0% +/-9% 21 Materials herein reflect public law 114-10 dated April 16, 2015
MIPS Summary Composite Performance Score • Consolidates existing quality reporting programs in Medicare Part B with Clinical Practice Improvement Activities Positive payment adjustments • Includes the potential for significant adjustments for “Exceptional Performers” Risk of payment penalty • Risk of negative payment adjustment if performance below threshold 22 Materials herein reflect public law 114-10 dated April 16, 2015
10 or fewer Combined score Geography or Specialty Written agreement One year commitment “All or nothing” 23 Virtual Groups Materials herein reflect public law 114-10 dated April 16, 2015
Alternative Payment Models (APMs) Materials herein reflect public law 114-10 dated April 16, 2015
Definitions Qualifying APM • Based on existing payment models Eligible APM • Based on criteria of the payment model Qualifying APM Participant • Based on individual physician payment or patient volume 25 Materials herein reflect public law 114-10 dated April 16, 2015
Qualifying APMs 26 • MSSP (Medicare Shares Savings Program) • CMS Innovation Center Model* • Demonstration under Medicare Healthcare Quality Demonstrations (MHCQ) or Acute Care Episode Demonstration • “Demonstration required by Federal Law” Qualifying APMs Materials herein reflect public law 114-10 dated April 16, 2015
Eligible APMs 27 • Quality measures comparable to MIPS • Use of certified EHR technology • More than nominal risk1 OR Medical Home model under CMMI authority 1 – Not yet defined Qualifying APMs Eligible APMs Materials herein reflect public law 114-10 dated April 16, 2015
Qualifying APM Participant 28 • Percentage of patients or payments thru eligible APM • In 2019, the threshold is 25% of Medicare payments. Patient threshold is yet to be determined. Qualifying APMs Eligible APMs Qualifying APM Participant Materials herein reflect public law 114-10 dated April 16, 2015
Additional Rewards for Qualifying Participants 29 • Not subject to MIPS • 5% bonus 2019-2024 • Higher fee schedule update 2026 Materials herein reflect public law 114-10 dated April 16, 2015
Summary of APMs Qualifying APMs • AAFP advocates for CMMI expansion to allow greater participation Eligible APMs • “nominal financial risk” Qualifying Participants • Potentially more financial certainty with a 5% annual bonus (and no potential for penalty) 30 Materials herein reflect public law 114-10 dated April 16, 2015
31 Yes No Am I in a Qualifying APM? Materials herein reflect public law 114-10 dated April 16, 2015
32 Yes No Am I in an eligible APM? Yes No Am I in a Qualifying APM? Materials herein reflect public law 114-10 dated April 16, 2015
33 Yes No Am I in an eligible APM? Enough payments or patients? Yes No Yes No Am I in a Qualifying APM? Materials herein reflect public law 114-10 dated April 16, 2015
34 Yes No Am I in an eligible APM? Enough payments or patients? Yes No Yes No Am I in a Qualifying APM? Qualifying APM Participant 5% bonus payment 2019-2024 Higher fee schedule 2026+ APM-specific rewards Excluded from MIPS Materials herein reflect public law 114-10 dated April 16, 2015
35 Yes No Am I in an eligible APM? Enough payments or patients? Yes No Yes No Am I in a Qualifying APM? Subject to MIPS Favorable MIPS scoring APM-specific rewards Materials herein reflect public law 114-10 dated April 16, 2015
36 Yes No Am I in an eligible APM? Subject to MIPS Favorable MIPS scoring APM-specific rewards Yes No Am I in a Qualifying APM? Materials herein reflect public law 114-10 dated April 16, 2015
37 Yes No 1st year in Medicare OR below low-volume threshold? Not subject to MIPS Yes No Am I in a Qualifying APM? Materials herein reflect public law 114-10 dated April 16, 2015
38 Yes No 1st year in Medicare OR below low-volume threshold? Subject to MIPS Yes No Am I in a Qualifying APM? Materials herein reflect public law 114-10 dated April 16, 2015
39 Yes No Am I in a Qualifying APM? Yes No Am I in an eligible APM? Enough payments or patients? Yes No Qualifying APM Participant 5% bonus payment 2019-2024 Higher fee schedule 2026+ APM-specific rewards Excluded from MIPS Yes No 1st year in Medicare OR below low-volume threshold? Not subject to MIPS Subject to MIPS Subject to MIPS Favorable MIPS scoring APM-specific rewards Materials herein reflect public law 114-10 dated April 16, 2015
MACRA Timeline 2016 2017 2018 2019 2020 2021 2022- 2024 2025 2026 Medicare Part B Baseline Payment Updates -.27% +0.5% +0.5% +0.5% 0% 0% 0% +0.25%* +0.75%** *Non-qualifying APM Conversion Factor **Qualifying APM Conversion Factor Merit-Based Incentive Payment System (MIPS) PQRS, Value-based Modifier, & Meaningful Use Quality, Resource Use, Meaningful Use, & Clinical Practice Improvement Activities -6% -9% -9%? +/-4% +/-5% +/-7% Qualifying APM Participant 5% Incentive payment Excluded from MIPS +0% +/-9% 40 Materials herein reflect public law 114-10 dated April 16, 2015
Technical Assistance 41 • $20 million for Technical Assistance 2016- 2020 Materials herein reflect public law 114-10 dated April 16, 2015
Payment Reform Is Here • Final regulations in 2016 • 2017 likely performance year for MIPS – Advocating for 2018 • Help is available 42 Materials herein reflect public law 114-10 dated April 16, 2015
What Can I Do Right Now? 1. Evaluate your practice – Are you submitting PQRS? – Have you reviewed your QRUR? – Attested for Meaningful Use? – Ask the Expert - aco@aafp.org 43 Materials herein reflect public law 114-10 dated April 16, 2015
What Can I Do Right Now? 2. Find a PTN – Go to aafp.org/tcpi – Click “Find a PTN” to find a practice transformation network in your area – Email tcpi@aafp.org with any questions. 44 Materials herein reflect public law 114-10 dated April 16, 2015
Family Practice Management Articles 45 FPM Journal Article - http://www.aafp.org/fpm/2015/1100/p19.pdf FPM Journal Article - http://www.aafp.org/fpm Materials herein reflect public law 114-10 dated April 16, 2015
AAFP.ORG/MACRA • FAQs • Timeline • MIPS/APM Comparison table • Related articles • Related links 46 Materials herein reflect public law 114-10 dated April 16, 2015
FMCC 2016 MACRA Plenary by Amy Mullins

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FMCC 2016 MACRA Plenary by Amy Mullins

  • 1.
    MACRA: Medicare's Shiftto Value-based Delivery & Payment Models Presented by Amy Mullins, MD, CPE
  • 2.
    Current State Over Utilization Volume over Value Silos of Care 2 Materialsherein reflect public law 114-10 dated April 16, 2015 2 Fee for Service
  • 3.
    Push Toward Value& Quality 3 • Medicare payments tied to quality or value by end of 2018 • Of those through alternative payment models (APMs) by end of 2016 • Private payer business through value-based arrangements by 202075% Materials herein reflect public law 114-10 dated April 16, 2015
  • 4.
    Medicare Access &CHIP Reauthorization Act (MACRA) 4 “To repeal the Medicare SGR and strengthen Medicare access by improving physician payments…” PhotoCourtesyofAmyMullins,MD Materials herein reflect public law 114-10 dated April 16, 2015
  • 5.
    What is MACRA? •Signed into law April 16, 2015 • Passed 392 to 37 in the House and 92 to 8 in the Senate 5 Materials herein reflect public law 114-10 dated April 16, 2015
  • 6.
    What Does MACRADo? • Repeals the Sustainable Growth Rate (SGR) • Extends Children’s Health Insurance Program (CHIP) funding for 2 years • Creates 2 payment tracks • Provides Annual Baseline Fee Schedule Updates 2016-2018 6 Materials herein reflect public law 114-10 dated April 16, 2015
  • 7.
    MACRA Timeline 2016 20172018 2019 2020 2021 2022- 2024 2025 2026 Medicare Part B Baseline Payment Updates -.27% +0.5% +0.5% +0.5% 0% 0% 0% +0.25%* +0.75%** *Non-qualifying APM Conversion Factor **Qualifying APM Conversion Factor +0% 7 Materials herein reflect public law 114-10 dated April 16, 2015
  • 8.
    Payment Models • Consolidatesquality programs Merit-Based Incentive Payment System (MIPS) • Potential for bonus payment for participation Alternative Payment Model (APM) 8 Materials herein reflect public law 114-10 dated April 16, 2015
  • 9.
    Merit-Based Incentive Payment System (MIPS) Materialsherein reflect public law 114-10 dated April 16, 2015
  • 10.
    MIPS Highlights Consolidates existingquality and value programs • To ease administrative burden Establishes a Performance Score • Adds a category for Clinical Practice Improvement Activities Opportunity for payment adjustments • Both positive and negative 10 Materials herein reflect public law 114-10 dated April 16, 2015
  • 11.
    Consolidates Quality &Value Programs 11 • Physician Quality Reporting System • Value Based Payment Modifier • Meaningful Use MIPS MU VBPM PQRS Materials herein reflect public law 114-10 dated April 16, 2015
  • 12.
    Establish Composite Performance Score 12 QualityResource Use Clinical Practice Improvement Activities Meaningful Use Materials herein reflect public law 114-10 dated April 16, 2015
  • 13.
    Clinical Practice Improvement Activities(CPIA) • Access • Population Management • Care Coordination • Beneficiary Engagement • Patient Safety • Participation in an Alternative Payment Model 13 Materials herein reflect public law 114-10 dated April 16, 2015
  • 14.
    Weighting by Category 20192020 2021 Quality 50% 45% 30% Resource Use 10% 15% 30% EHR MU 25% 25% 25% CPIA1 15% 15% 15% 1 - “Certified” patient-centered medical home will receive the full 15 points for CPIA 14 Materials herein reflect public law 114-10 dated April 16, 2015
  • 15.
    “Certified” Patient-Centered Medical Home(PCMH) 15 • Not defined in law • Joint Principles of PCMH • Functions of Comprehensive Primary Care (CPC) – Risk-Stratified Care Management – Access and Continuity – Planned Care for Chronic Conditions and Preventive Care – Patient and Caregiver Engagement – Care Coordination Across the Medical Neighborhood Materials herein reflect public law 114-10 dated April 16, 2015
  • 16.
    Annual Performance Threshold •Established by Secretary years 1 and 2 • Mean or median of previous year’s MIPS scores • Below = negative payment adjustments • Above = positive payment adjustments 16 Materials herein reflect public law 114-10 dated April 16, 2015
  • 17.
    Adjust Payments -4% -5% -7% -9% 4% 5% 7% 9% 20192020 2021 2022 onward “With respect to positive MIPS adjustment factors…the Secretary shall increase or decrease such adjustment factors by a scaling factor in order to ensure that the budget neutrality requirement …is met” 17 Materials herein reflect public law 114-10 dated April 16, 2015
  • 18.
    Adjust Payments 18 -4% -5% -7% -9% 12% 15% 21% 27% 4% 5% 7% 9% 20192020 2021 2022 onward Adjustment to provider’s base rate of Medicare Part B payment Maximum Adjustments Materials herein reflect public law 114-10 dated April 16, 2015
  • 19.
    Exemptions 19 • Year 1Medicare • Eligible APMs with Bonus • Below low volume threshold • Federally Qualified Health Clinics and Rural Health Clinics Materials herein reflect public law 114-10 dated April 16, 2015
  • 20.
    Adjustment Summary 20 Performance ScorePayment Adjustment Lowest quartile = Maximum negative adjustment At threshold = No adjustment “Exceptional Performers” = Eligible for up to 10% positive adjustment “Exceptional Performers” has yet to be defined Materials herein reflect public law 114-10 dated April 16, 2015
  • 21.
    MACRA Timeline 2016 20172018 2019 2020 2021 2022- 2024 2025 2026 Medicare Part B Baseline Payment Updates -.27% +0.5% +0.5% +0.5% 0% 0% 0% +0.25%* +0.75%** *Non-Qualifying APM Conversion Factor **Qualifying APM Conversion Factor Merit-Based Incentive Payment System (MIPS) PQRS, Value-based Modifier, & Meaningful Use Quality, Resource Use, Meaningful Use, & Clinical Practice Improvement Activities -6% -9% -9%? +/-4% +/-5% +/-7% +0% +/-9% 21 Materials herein reflect public law 114-10 dated April 16, 2015
  • 22.
    MIPS Summary Composite PerformanceScore • Consolidates existing quality reporting programs in Medicare Part B with Clinical Practice Improvement Activities Positive payment adjustments • Includes the potential for significant adjustments for “Exceptional Performers” Risk of payment penalty • Risk of negative payment adjustment if performance below threshold 22 Materials herein reflect public law 114-10 dated April 16, 2015
  • 23.
    10 or fewer Combined score Geography orSpecialty Written agreement One year commitment “All or nothing” 23 Virtual Groups Materials herein reflect public law 114-10 dated April 16, 2015
  • 24.
    Alternative Payment Models (APMs) Materialsherein reflect public law 114-10 dated April 16, 2015
  • 25.
    Definitions Qualifying APM • Basedon existing payment models Eligible APM • Based on criteria of the payment model Qualifying APM Participant • Based on individual physician payment or patient volume 25 Materials herein reflect public law 114-10 dated April 16, 2015
  • 26.
    Qualifying APMs 26 • MSSP(Medicare Shares Savings Program) • CMS Innovation Center Model* • Demonstration under Medicare Healthcare Quality Demonstrations (MHCQ) or Acute Care Episode Demonstration • “Demonstration required by Federal Law” Qualifying APMs Materials herein reflect public law 114-10 dated April 16, 2015
  • 27.
    Eligible APMs 27 • Qualitymeasures comparable to MIPS • Use of certified EHR technology • More than nominal risk1 OR Medical Home model under CMMI authority 1 – Not yet defined Qualifying APMs Eligible APMs Materials herein reflect public law 114-10 dated April 16, 2015
  • 28.
    Qualifying APM Participant 28 •Percentage of patients or payments thru eligible APM • In 2019, the threshold is 25% of Medicare payments. Patient threshold is yet to be determined. Qualifying APMs Eligible APMs Qualifying APM Participant Materials herein reflect public law 114-10 dated April 16, 2015
  • 29.
    Additional Rewards for QualifyingParticipants 29 • Not subject to MIPS • 5% bonus 2019-2024 • Higher fee schedule update 2026 Materials herein reflect public law 114-10 dated April 16, 2015
  • 30.
    Summary of APMs QualifyingAPMs • AAFP advocates for CMMI expansion to allow greater participation Eligible APMs • “nominal financial risk” Qualifying Participants • Potentially more financial certainty with a 5% annual bonus (and no potential for penalty) 30 Materials herein reflect public law 114-10 dated April 16, 2015
  • 31.
    31 Yes No Am Iin a Qualifying APM? Materials herein reflect public law 114-10 dated April 16, 2015
  • 32.
    32 Yes No Am Iin an eligible APM? Yes No Am I in a Qualifying APM? Materials herein reflect public law 114-10 dated April 16, 2015
  • 33.
    33 Yes No Am Iin an eligible APM? Enough payments or patients? Yes No Yes No Am I in a Qualifying APM? Materials herein reflect public law 114-10 dated April 16, 2015
  • 34.
    34 Yes No Am Iin an eligible APM? Enough payments or patients? Yes No Yes No Am I in a Qualifying APM? Qualifying APM Participant 5% bonus payment 2019-2024 Higher fee schedule 2026+ APM-specific rewards Excluded from MIPS Materials herein reflect public law 114-10 dated April 16, 2015
  • 35.
    35 Yes No Am Iin an eligible APM? Enough payments or patients? Yes No Yes No Am I in a Qualifying APM? Subject to MIPS Favorable MIPS scoring APM-specific rewards Materials herein reflect public law 114-10 dated April 16, 2015
  • 36.
    36 Yes No Am Iin an eligible APM? Subject to MIPS Favorable MIPS scoring APM-specific rewards Yes No Am I in a Qualifying APM? Materials herein reflect public law 114-10 dated April 16, 2015
  • 37.
    37 Yes No 1st yearin Medicare OR below low-volume threshold? Not subject to MIPS Yes No Am I in a Qualifying APM? Materials herein reflect public law 114-10 dated April 16, 2015
  • 38.
    38 Yes No 1st yearin Medicare OR below low-volume threshold? Subject to MIPS Yes No Am I in a Qualifying APM? Materials herein reflect public law 114-10 dated April 16, 2015
  • 39.
    39 Yes No Am Iin a Qualifying APM? Yes No Am I in an eligible APM? Enough payments or patients? Yes No Qualifying APM Participant 5% bonus payment 2019-2024 Higher fee schedule 2026+ APM-specific rewards Excluded from MIPS Yes No 1st year in Medicare OR below low-volume threshold? Not subject to MIPS Subject to MIPS Subject to MIPS Favorable MIPS scoring APM-specific rewards Materials herein reflect public law 114-10 dated April 16, 2015
  • 40.
    MACRA Timeline 2016 20172018 2019 2020 2021 2022- 2024 2025 2026 Medicare Part B Baseline Payment Updates -.27% +0.5% +0.5% +0.5% 0% 0% 0% +0.25%* +0.75%** *Non-qualifying APM Conversion Factor **Qualifying APM Conversion Factor Merit-Based Incentive Payment System (MIPS) PQRS, Value-based Modifier, & Meaningful Use Quality, Resource Use, Meaningful Use, & Clinical Practice Improvement Activities -6% -9% -9%? +/-4% +/-5% +/-7% Qualifying APM Participant 5% Incentive payment Excluded from MIPS +0% +/-9% 40 Materials herein reflect public law 114-10 dated April 16, 2015
  • 41.
    Technical Assistance 41 • $20million for Technical Assistance 2016- 2020 Materials herein reflect public law 114-10 dated April 16, 2015
  • 42.
    Payment Reform IsHere • Final regulations in 2016 • 2017 likely performance year for MIPS – Advocating for 2018 • Help is available 42 Materials herein reflect public law 114-10 dated April 16, 2015
  • 43.
    What Can IDo Right Now? 1. Evaluate your practice – Are you submitting PQRS? – Have you reviewed your QRUR? – Attested for Meaningful Use? – Ask the Expert - aco@aafp.org 43 Materials herein reflect public law 114-10 dated April 16, 2015
  • 44.
    What Can IDo Right Now? 2. Find a PTN – Go to aafp.org/tcpi – Click “Find a PTN” to find a practice transformation network in your area – Email tcpi@aafp.org with any questions. 44 Materials herein reflect public law 114-10 dated April 16, 2015
  • 45.
    Family Practice Management Articles 45 FPMJournal Article - http://www.aafp.org/fpm/2015/1100/p19.pdf FPM Journal Article - http://www.aafp.org/fpm Materials herein reflect public law 114-10 dated April 16, 2015
  • 46.
    AAFP.ORG/MACRA • FAQs • Timeline •MIPS/APM Comparison table • Related articles • Related links 46 Materials herein reflect public law 114-10 dated April 16, 2015