Another Year of COVID-19, Another MIPS Automatic Extreme and Uncontrollable Circumstances Policy

The Centers for Medicare and Medicaid Services (CMS) is once again applying an Automatic Extreme and Uncontrollable Circumstances (EUC) Policy for the 2021 MIPS Performance Year in response to the COVID-19 Public Health Emergency (PHE).

The policy affects providers differently depending on how they report MIPS. For instance, the automatic EUC policy applies only to MIPS eligible clinicians who participate in MIPS as individuals and not to groups, virtual groups, or Alternative Payment Model (APM) Entities.

However, because reporting beyond the individual level is optional in most cases, if groups and APM entities are not able to report MIPS data for 2021, the individually eligible MIPS clinicians in those groups and APM entities will still qualify for the automatic EUC policy. Virtual groups and some small practices operate under different guidelines, however, and their members may not benefit from the automatic policy.

Here’s a breakdown of how the policy will affect providers based on how they choose to report MIPS.

Determine Eligibility

First things first. Before providers can determine how the automatic EUC policy will affect them, they should first determine if it will affect them by confirming that they are eligible providers for the 2021 MIPS Performance Year.

Providers can now visit the Quality Payment Program (QPP) Participation Status Tool to review their final 2021 MIPS eligibility status. CMS recently updated provider eligibility status based on a review of Medicare Part B claims and Medicare Provider Enrollment, Chain, and Ownership System (PECOS) data from the second segment of the MIPS Eligibility Determination Period (October 1, 2020 – September 30, 2021).

In some cases, a provider’s eligibility status may have changed from previous years and/or earlier calculations of 2021 MIPS eligibility status. If, after a review of data from the first segment of the MIPS Eligibility Determination Period (October 1, 2019 – September 30, 2020), a provider was determined to be:

Eligible for MIPS: Their eligibility status could have changed, and they may no longer be eligible. Use the tool to make sure they’re still eligible.
Not eligible for MIPS at a particular practice: Their eligibility status, based on their association with that particular practice, didn’t change.

If a provider joined a new practice (meaning they billed under, or assigned their billing rights to, a new or different Tax Identification Number (TIN)), their eligibility status may also have changed.

If they joined a new practice between October 1, 2020, and September 30, 2021, CMS evaluated MIPS eligibility status based on their association with that new practice (identified by TIN) for this second review.
If they joined a new practice after September 30, 2021, they aren’t eligible for MIPS as an individual based on their association with that new practice (identified by TIN). However, they may be eligible to receive a MIPS payment adjustment based on their group’s participation, if the new practice they joined chooses to participate in MIPS as a group.

Reporting MIPS as an Individual

Providers who report MIPS as individuals do not need to take any action to have the automatic EUC policy applied to them. Individual providers will be automatically identified, will have all four MIPS performance categories reweighted to 0 percent, and will receive a neutral payment adjustment for the 2023 MIPS payment year unless

They submit data in 2 or more performance categories as an individual, or
They have a higher final score from group or APM Entity participation.

Additionally, the cost performance category will always be weighted at 0%, even if they submitted data for the other performance categories.

Small Practices Reporting Medicare Part B Claims Measures

Clinicians in small practices that report Medicare Part B claims measures and who are only eligible to participate in MIPS as part of a group aren’t covered by the automatic EUC policy and will receive the group’s final score.

Some small practices may not be aware of the implications of their 2021 claims reporting due to current CMS policies introduced at the onset of the COVID-19 PHE that automatically calculate a quality score from Medicare Part B claims measures at the individual and group level. As a result, these small practices may wish to request performance category reweighting on behalf of the group through the 2021 EUC Exception Application, citing COVID-19 as the triggering event.

2021 EUC Exception Applications can be submitted through December 31, 2021, by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation.

To determine whether a clinician falls into this category, sign in to qpp.cms.gov, navigate to the “Eligibility & Reporting” page and click “View Clinician Eligibility.” Clinicians who are only eligible to participate as part of a group will have a green check mark next to “Group”; there won’t be a green check mark next to “Individual”.

Groups and APM Entities

This latest automatic EUC policy doesn’t apply to groups or APM Entities. However, groups and APM Entities who are not able to submit data for the 2021 performance year don’t need to take any further action since participation in these reporting mechanisms is optional, and individually eligible MIPS clinicians in their group or APM Entity will qualify for the automatic EUC policy if they don’t report at the group/APM Entity-level on their behalf.

If data is submitted at the group or APM Entity level on behalf of MIPS eligible clinicians, the group or APM Entity will receive a MIPS final score based on the data submitted. However, those MIPS eligible clinicians will still have all four performance categories reweighted to 0 percent and receive a neutral payment adjustment for the 2023 MIPS payment year as individuals unless

They submit data in 2 or more performance categories as an individual, or
They have a higher final score from group or APM Entity participation.

If a group or APM Entity would like to request performance category reweighting for the 2021 performance year, they can submit an EUC application through December 31, 2021, by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation.

According to the COVID-19 Response Fact Sheet, when an EUC Exception application is approved by CMS for a group, the performance categories selected in the application will be weighted at 0% and won’t contribute to the final MIPS score unless data is submitted for those performance categories. Any data submitted will be scored.

However, for APM Entities, different EUC application guidelines apply.

APM Entities are required to request reweighting for all performance categories; they aren’t able to select some, but not all, performance categories.
At least 75% of the MIPS eligible clinicians in the Entity must qualify for reweighting in the Promoting Interoperability performance category.
Data submission by an APM Entity won’t override performance category reweighting, which means APM Entities with an approved application will receive a final score equal to the performance threshold and their MIPS eligible clinicians will receive a neutral payment adjustment even if data were submitted.

Virtual Groups

This latest automatic EUC policy doesn’t apply to virtual groups, either, and MIPS eligible clinicians in a virtual group will receive a payment adjustment based on the virtual group’s final score, even if no data is submitted, which would result in the maximum negative payment adjustment of -9 percent in the 2023 payment year.

Virtual groups unable to submit MIPS data for the 2021 performance year as a result of the ongoing COVID-19 PHE should submit a 2021 EUC Exception Application to request reweighting for all 4 performance categories.

As mentioned previously, 2021 EUC Exception Applications can be submitted through December 31, 2021, by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation. As with groups, when an EUC exception application is approved by CMS for a virtual group, the performance categories selected in the application will be weighted at 0% and won’t contribute to the final MIPS score unless data is submitted for those performance categories. Any data submitted will be scored.

Medicare Shared Savings Program ACOs

The MIPS Automatic EUC policy doesn’t apply to Shared Savings Program Accountable Care Organizations (ACOs). ACOs can submit a 2021 EUC Exception Application on behalf of its MIPS eligible clinicians if they are unable to report via the Alternative Payment Model (APM) Performance Pathway (APP).

To submit a 2021 EUC Exception Application, ACOs must demonstrate that greater than 75 percent of its MIPS eligible clinicians would be eligible for reweighting the Promoting Interoperability performance category. ACOs can submit 2021 EUC Exception Applications through December 31, 2021, by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation.

In addition, CMS also will apply the Shared Savings Program Quality EUC policy, which considers all ACOs to be affected by the COVID-19 PHE, to Medicare Shared Savings Program ACOs to determine shared savings and losses for performance year 2021. That means ACOs that are able to report quality data via the APP and meet MIPS data completeness and case minimum requirements will receive the higher of their ACO quality score or the 30th percentile MIPS quality performance category score. ACOs that are unable to report quality data via the APP and meet the MIPS quality data completeness and case minimum requirements, will have their quality score set equal to the 30th percentile MIPS quality performance category score.