CMS to automatically apply ‘extreme and uncontrollable circumstances’ policy to some MIPS participants

The Centers for Medicare & Medicaid Services (CMS) announced Nov. 10 that it will automatically apply the "extreme and uncontrollable circumstances" (EUC) policy to the 2021 Merit-based Incentive Payment System (MIPS) performance year. The EUC policy will apply to eligible clinicians (ECs) who are allowed to participate in MIPS as individuals. It will not apply to groups, virtual groups, or alternative payment model (APM) entities.

Individual ECs do not need to take any action. CMS will automatically identify them and reweight all four MIPS performance categories to 0%. This means individual ECs will receive a neutral payment adjustment for the 2023 MIPS payment year unless they submit data for two or more categories or have a higher final score from group or APM entity participation.

Small groups (15 or fewer ECs) that report via Medicare Part B claims and are only eligible to participate in MIPS as a group do not qualify for the automatic EUC policy. They can check the Quality Payment Program website to view the eligibility for the individual clinicians within the group. Clinicians who are only eligible to participate as a group will have a green check mark next to “Group.” While the automatic policy does not apply these groups, they can request performance category reweighting through the PY2021 EUC Exception Application on the QPP website. They should cite the COVID-19 pandemic as the triggering event. Applications for the 2021 performance year are due Dec. 31.

Other groups and APM entities (e.g., those with ECs who are eligible to participate as individuals) do not need to take any action, because group and APM entity participation for those ECs is optional. CMS will apply the EUC policy to the individual ECs within the group if the group does not submit group-level data on the clinicians' behalf. If a group submits data, they will receive a final score for the 2021 MIPS performance year.

Virtual groups will receive a final score and payment adjustment, even if they do not submit data. If a virtual group does not submit data, ECs in the group will receive the maximum negative payment adjustment in 2023. Virtual groups may also apply for reweighting and cite the COVID-19 pandemic as the reason.

As a reminder, CMS reopened the EUC application period for the 2020 performance year. ECs, groups, and APM Entities may request reweighting through the 2020 Targeted Review Form until Nov. 29. Applicants must specify which categories they would like reweighted and should state explicitly in the description that the EUC application is due to the ongoing COVID-19 public health emergency. CMS is already automatically applying the EUC policy to clinicians eligible to participate as individuals for the 2020 performance year.

Additional information is available in the 2021 MIPS Extreme and Uncontrollable Circumstances Application Guide and Quality Payment Program COVID-19 Response Fact Sheet. Practices may also contact the QPP at 1-866-288-8292, Monday through Friday, 8 a.m. to 8 p.m. ET.

— Erin Solis, manager of practice and payment, American Academy of Family Physicians

Posted on Nov. 10, 2021, by Erin Solis