MIPS Extreme and Uncontrollable Circumstances Flexibilities Extended for 2020

The Centers for Medicare and Medicaid Services (CMS) is automatically applying its extreme and uncontrollable circumstances (EUC) policy to all MIPS eligible clinicians for the 2020 performance period. The agency also is reopening the MIPS EUC application for individual MIPS eligible clinicians, groups, virtual groups, and Alternative Payment Model (APM) Entities through March 31, 2021 at 8 p.m. ET.

The changes come as part of CMS’s continued response to the Coronavirus (COVID-19) pandemic. What these changes mean for providers mostly depends on what, if anything, they have done so far for the 2020 MIPS performance period. According to CMS, applications received between now and March 31, 2021, generally won’t override previously submitted data for individuals, groups and virtual groups.

Here’s how the updated flexibilities will apply to various groups based on what, if any, data they have submitted.

Individual Clinicians, Groups, and Virtual Groups That Haven’t Submitted Data

Individual MIPS eligible clinicians who haven’t submitted any data won’t need to take any additional action to qualify for the automatic EUC policy. They will be automatically identified and will receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) they submit data as an individual in 2 or more performance categories, or 2) their practice reports as a group, by submitting data for one or more performance category.

Groups also won’t need to take any further action if they’re not able to submit data for the 2020 performance period. Group participation is optional, and the individual MIPS eligible clinicians within the group already qualify for the automatic EUC policy. Groups will have all 4 performance categories reweighted to 0% and receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) the individual members submit data in 2 or more performance categories as individuals, or 2) the practice reports as a group, by submitting data for one or more performance category.

Virtual Groups must submit an EUC application for all 4 performance categories by the deadline in order to be considered for the exception.

Individual Clinicians, Groups, and Virtual Groups That Have Submitted Data

Individual MIPS eligible clinicians that have submitted data for a single performance category don’t need to take any additional action to be eligible for the automatic EUC policy. They will be automatically identified and have all 4 performance categories reweighted to 0% and will receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) they submit data for another performance category, or 2) their group submits data for one or more performance categories.

Individual MIPS eligible clinicians that have submitted data as an individual for 2 or 3 performance categories will receive a MIPS final score and MIPS payment adjustment for the 2022 MIPS payment year based on the data they’ve submitted. They cannot submit an application to override previously submitted data; however, they will only be scored in the performance categories for which data was submitted.

Groups and virtual groups that have submitted data for a single performance category but are not able to complete data submission for other performance categories, can submit an application to request reweighting in all 4 performance categories. If the application is approved and no data is submitted for any other performance category, their MIPS eligible clinicians will receive a neutral payment adjustment for the 2022 MIPS payment year. Groups in this category that don’t submit an application will be scored in all performance categories unless they are eligible for reweighting in one or more performance categories based on other criteria.

Groups and virtual groups that have submitted data for 2 or 3 performance categories will receive a MIPS final score and MIPS payment adjustment for the 2022 MIPS payment year. They cannot submit an application to override previously submitted data, and they will be scored in all performance categories unless they qualify for reweighting in one or more performance categories based on other criteria.

APM Entities

APM Entities participating in MIPS APMs can submit an EUC application, though there are some differences from the MIPS EUC policy for individuals, groups, and virtual groups. For one, APM Entities are required to request reweighting for all performance categories. Also, more than 75% of the MIPS eligible clinicians in the APM Entity must be eligible for reweighting in the Promoting Interoperability performance category. And if approved, an APM Entity’s approved application for performance category weighting will override previously submitted data, unlike applications for individuals, groups and virtual groups.

The EUC policy is not automatic for APM entities. MIPS eligible clinicians of any APM entity that doesn’t report for the 2020 performance period or have an approved EUC application will receive a negative payment adjustment in the 2022 payment year.

Submitting Data

Those MIPS Eligible Clinicians who are still planning to submit data for the 2020 performance year have until 8:00 p.m. EDT, March 31, 2021, to do so by following these steps:

Go to the Quality Payment Program webpage.
Sign in using your QPP access credentials.
Submit your MIPS data for the 2020 performance year or review the data reported on your behalf by a third party.