The Centers for Medicare and Medicaid Services (CMS) recently released regulatory guidance for clinicians participating in the Merit-Based Incentive Payment System (MIPS) who have been adversely impacted by Hurricanes Irma, Harvey and Maria, as well as the ongoing Northern California Wildfires.
ACG Advocacy Paying Off – Exemptions for
Hard Hit Hurricane Areas
This is welcomed news, as ACG has been urging CMS to grant these exemptions for ACG members impacted by these natural disasters. ACG also championed a resolution at the recent American Medical Association (AMA) House of Delegates meeting to urge the AMA and others to advocate for more regulatory waivers for providers impacted by recent hurricanes.
The “Extreme and Uncontrollable Circumstances” policy grants certain clinicians exceptions without having to submit an extraordinary circumstances exception request. What do extreme and uncontrollable circumstances mean for the MIPS Transition Year scoring?
Here’s how your scoring will be affected if you’ve faced extreme and uncontrollable circumstances:
- CMS will assign a weight of 0% in the MIPS final score for each performance category in which data is not submitted by the applicable deadline.
- If you don’t submit any data in 2017, you will not receive a MIPS payment cut in 2019.
- If you’re eligible for reweighting due to extreme and uncontrollable circumstances but still choose to report on one or more performance categories (either as an individual or group), you will be scored on those performance categories, and your MIPS payment adjustment will be based on your final score. The performance category or categories won’t be reweighted to 0% in the 2017 final score, and you may be eligible for a MIPS bonus.
- Group practices will only be scored as a group if they submit information to MIPS as a group. If a group is located in an affected area and does not submit any data, clinicians in that group will be treated as individual reporters: they will each receive a MIPS final score equal to the performance threshold, and will avoid a payment cut.
- Please note: If you are eligible for reweighting due to extreme and uncontrollable circumstances but still choose to report on one or more MIPS performance categories (either as an individual or group), you’ll be scored on those performance categories and your MIPS payment adjustment will be based on your final score.
- Please note: This policy does not apply to MIPS-eligible clinicians in MIPS alternative payment models (MIPS APMs) in 2017.
Key takeaway for impacted providers and groups: only submit MIPS data if you are sure you will at least avoid a payment cut and could potentially receive a payment bonus.
How do I know if I am located in an impacted area? A list of impacted areas can be found on CMS’ Emergency Response and Recovery page and include:
- All 67 counties in Florida
- All 159 counties in Georgia
- All 64 parishes of Louisiana
- All 78 municipios in Puerto Rico
- All 46 counties and the Catawba Indian Nation of South Carolina
- The following counties in Texas: Aransas; Austin; Bee; Brazoria; Calhoun; Chambers; Colorado; Dewitt; Fayette; Fort Bend; Galveston; Goliad; Gonzales; Harris; Jackson; Jefferson; Jim Wells; Karnes; Kleberg; Lavaca; Liberty; Live Oak; Matagorda; Nueces; Refugio; San Patricio; Victoria; Waller; Wharton; and Wilson
- All of the U.S. Virgin Islands.
- The Extreme and Uncontrollable Circumstances policy applies to MIPS-eligible clinicians affected by the Northern California Wildfires. These clinicians will be granted exceptions without having to submit an extraordinary circumstances exception request if they’re located in one of the California counties designated by the Federal Emergency Management Agency (FEMA) as a major disaster county.
ACG will continue to advocate for members and GI practices impacted by recent hurricanes and fires.
Whitfield L. Knapple, MD, FACG
Chair, ACG Legislative and Public Policy Council