CMS Just Proposed Sunsetting Traditional MIPS: Here's Everything ACOs and MIPS Clinicians Need to Know About the CY2027 Rule
Ten years after MACRA created MIPS, CMS has proposed an end date. Buried in the CY 2027 Physician Fee Schedule proposed rule (CMS-1848-P, released July 2026) is the clearest signal yet that traditional MIPS reporting is going away, and it's not the only headline. Between a new double-rate ACO payment incentive, a major MSSP benchmarking overhaul, and a reshuffled Promoting Interoperability category, this is one of the most consequential years for value-based care policy in recent memory.
The Headline: Traditional MIPS Is Being Sunset
CMS is proposing that MIPS Value Pathways (MVPs) become the only MIPS reporting option beginning with the CY 2029 performance period/2031 MIPS payment year. Traditional MIPS reporting would remain available through the CY 2028 performance period and then disappear. If finalized, this closes a chapter that's been open since 2017; CMS has talked about eventually retiring traditional MIPS for years, but this is the first time an actual sunset date has been proposed.
Three new MVPs are proposed for the transition: Diabetic Disease, Hypertension, and Hospitalist. Notably, CMS frames the Diabetic Disease and Hypertension MVPs explicitly around the administration's "Making America Healthy Again" (MAHA) initiative, describing a shift toward prevention and "restoring foundational wellness" rather than just chronic disease management after the fact. That same MAHA framing shows up again in the Improvement Activities category (more below).
What this means practically: if you're not already thinking about which MVP fits your practice, this rule gives you roughly two more performance years (2027 and 2028) before MVP reporting becomes mandatory. Groups and virtual groups would also be brought into MVP reporting as part of this transition.
MIPS Quality Category: A Real Housecleaning
CMS is proposing a genuinely large refresh of the measure inventory for the CY 2027 performance period/2029 MIPS payment year:
180 total MIPS quality measures (177 usable in traditional MIPS, 3 MVP-only).
20 measures removed, 10 added for 2027 (one more added in 2028), and 43 substantively modified.
Removals target low-bar process measures, topped-out measures, duplicative measures, and measures nobody's really using (no benchmark, poor data).
Additions lean toward patient-reported outcomes and chronic disease management, consistent with the broader MAHA-aligned prevention push.
A new "MIPS core measure" concept replaces the old outcome/high-priority measure requirement. Instead of requiring one outcome measure (or one high-priority measure as a fallback), clinicians would need to report at least one designated "MIPS core measure", with an attestation option if none applies, and an exemption for small practices. The "high priority measure" designation itself is being retired as both a measure label and a retention criterion.
Promoting Interoperability: A Temporary Softening, Then a Tightening
This one's a bit of a rollercoaster, and it's easy to get the sequencing backwards:
CY 2027 performance period: The Electronic Prior Authorization measure, currently required, would become optional, worth 10 bonus points instead.
CY 2028 performance period: Electronic Prior Authorization becomes required again, with an updated measure description, and CMS adds a brand-new required measure: Electronic Prior Authorization for Prescription Drugs, under the Health Information Exchange objective.
Also proposed: removing the Security Risk Analysis measure entirely, and updating the CEHRT definition to align with ONC's parallel deregulatory proposal (HTI-5).
So if you were bracing for prior authorization reporting to get harder in 2027, it actually gets easier for one year, then significantly harder in 2028, when it doubles into two required measures.
MIPS Scoring Weights and the Performance Threshold, Confirmed
For the CY 2027 performance period/2029 MIPS payment year, the four category weights are confirmed at: 30% Quality, 30% Cost, 25% Promoting Interoperability, 15% Improvement Activities. The performance threshold holds at 75 points, no proposed increase, continuing CMS's recent posture of stability while it reworks everything else around the edges.
Improvement Activities Get a MAHA Makeover
CMS proposes adding six new improvement activities split across two subcategories - Care Coordination and a brand-new Advancing Health and Wellness subcategory, while modifying five existing activities and removing eleven. The new subcategory is explicitly framed around nutrition, lifestyle-based disease management, and patient wellness, mirroring the same MAHA language used in the MVP additions.
ACO Visits Get a Higher-Value Complexity Add-On Under CMS’s Proposed E/M Modifier Changes.
CMS proposes replacing G2211 with MOD1 and MOD2, where MOD2 is valued at 32% of the E/M service’s total RVUs and is reserved for E/M visits furnished within an ACO, creating a higher payment level for ACO-related visits than the general-use modifier.
MSSP: CMS Is Rebalancing BASIC vs. ENHANCED Track Economics
The Shared Savings Program now covers 511 ACOs, over 700,000 providers, and 12.6 million assigned beneficiaries as of January 2026, and CMS's own data shows ACOs have been drifting toward the ENHANCED track based on financial architecture rather than genuine cost-saving capacity. The fix comes as four coordinated benchmarking changes:
BASIC track Level E sharing rate rises from 50% to 60% - narrowing the gap with ENHANCED's 75% rate.
ENHANCED track's positive regional adjustment cap falls from 50% to 35%.
Prior savings adjustment scaling factor rises from 50% to 75% - more protection against the benchmark "ratchet effect".
The 5% cap on upward benchmark adjustments becomes risk-adjusted, so ACOs with sicker populations aren't unfairly squeezed.
A new growth adjustment would reward ACOs for recruiting clinicians and beneficiaries new to value-based care, and CMS proposes an ACPT guardrail limiting how far projected cost trends can drift from actual national growth (capped at 1 point below or 1.5 points above).
ACOs Could Soon Waive Your Copay
Borrowing from lessons learned in ACO REACH, CMS proposes letting ACOs reduce or eliminate Part B cost sharing for beneficiaries starting as early as April 2027 (excluding DMEPOS and drugs), pending CMS approval of an implementation plan. In exchange, the underused prepaid shared savings payment option would be phased out.
Quality Reporting Relief for ACOs
CMS proposes real administrative relief for ACOs specifically:
A new Medicare eCQMs collection type letting ACOs report on just their assigned Medicare population instead of wrestling with all-payer data aggregation.
CEHRT use requirements loosened - ACOs could satisfy the requirement through one of three simplified paths instead of full Promoting Interoperability reporting.
The APP Plus quality measure set shrinks slightly (dropping Substance Use Disorder Treatment and Adult Immunization Status measures).
ACOs could exclude underperforming or closed participant TINs from quality submission, as long as TINs covering at least 95% of assigned beneficiaries are still reported.
Bottom Line
This rule reads like CMS trying to finish what it started a decade ago: retire the reporting option (traditional MIPS), simplify quality reporting where it's genuinely burdensome (ACO CEHRT requirements), and put real money behind the behavior it wants more of (the ACO-specific E/M modifier). None of it is final. If you're weighing an MVP selection, a BASIC-to-ENHANCED track move, or your practice's readiness for mandatory electronic prior authorization in 2028, the comment period (open until September 14, 2026) is the moment to weigh in.
