This Week in Washington DC – February 27, 2021

From ACG Legislative and Public Policy Council Chair, James C. Hobley, MD, MSc, FACG

Sen. Lisa Murkowski (R-AK) and Senate colleagues recently introduced the Safe Step Act of 2021 (S. 464). S. 464 limits the use of step therapy protocols for group health plans regulated by ERSA. The House companion bill is expected to be introduced soon. Eliminating step therapy and prior authorization requirements continues to be among ACG's top public policy goals. Tell your Senators to support this important bill using the link below.

On Thursday, February 25th, the Centers for Medicare and Medicaid Services (CMS) announced that all MIPS eligible providers will be granted an extreme and uncontrollable circumstances (EUC) waiver and will not be subject to a Medicare reimbursement cut in CY 2022.

CMS is also reopening the extreme and uncontrollable circumstances application for individual MIPS eligible clinicians, groups, virtual groups, and Alternative Payment Model (APM) Entities through March 31, 2021.

What does this mean? You will automatically receive a score equal to the 2020 MIPS performance threshold, which will result in a neutral payment adjustment (neither a positive nor a negative adjustment) for the 2022 MIPS payment year unless:

• You submit data as an individual for 2 or more MIPS performance categories (Quality, Improvement Activities, and/or Promoting Interoperability);
• You are part of a group that submits data on behalf of its clinicians; or
• You are part of a virtual group.

If you have not submitted 2020 data:

• Individual MIPS eligible clinicians: ACG members do not need to take any additional action to qualify for the automatic policy. You will receive a neutral payment adjustment (0% adjustment) for the 2022 MIPS payment year unless:
  • You submit data as an individual in 2 or more MIPS performance categories, or
  • Your practice reports as a group, by submitting data for one or more performance category.
• Groups: ACG members participating in group reporting do not need to take any further action if you are not able to submit data for the 2020 performance period. Group participation is optional, and individual MIPS eligible clinicians qualify for the automatic EUC policy. As noted above, individuals will have all 4 performance categories reweighted to 0% and receive a neutral payment adjustment for the 2022 MIPS payment year unless 1) they 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: If you’re unable to submit data for the 2020 performance period, you must submit an EUC application for all 4 performance categories by the deadline.

If you already submitted 2020 data:

• Individual MIPS eligible clinicians that have submitted data for a single performance category: You do not need to take any additional action to be eligible for the automatic EUC policy. You’ll 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) you submit data for another performance category, or 2) your group submits data for one or more performance category.
• Individual MIPS eligible clinicians that have submitted data as an individual for 2 or 3 performance categories: You will receive a MIPS final score and MIPS payment adjustment for the 2022 MIPS payment year based on the data submitted. You will only be scored in the performance categories for which data are submitted.
  • You cannot submit an application to override previously submitted data.

• Groups and virtual groups that have submitted data for a single performance category: If you are not able to complete data submission for other performance categories, you can submit an application to request reweighting in all 4 performance categories.
  • This includes small practices that were automatically scored as a group on Medicare Part B Claims measures submitted throughout the 2020 performance period.
  • If you do not submit an application, your group will be scored in all performance categories unless you are eligible for reweighting in one or more performance categories.
  • If your application is approved and data is not submitted for another performance category, your MIPS eligible clinicians will receive a neutral payment adjustment for the 2022 MIPS payment year.

• Groups and virtual groups that have submitted data for 2 or 3 performance categories: Your MIPS eligible clinicians will receive a MIPS final score and MIPS payment adjustment for the 2022 MIPS payment year. Your group will be scored in all performance categories unless you qualify for reweighting in one or more performance categories.
  • You cannot submit an application to override previously submitted data.

APM Entities:
Entities participating in MIPS APMs can submit an EUC application with some differences from the MIPS EUC policy for individuals, groups, and virtual groups:

• APM Entities are required to request reweighting for all performance categories.
• More than 75% of the MIPS eligible clinicians in the APM Entity must be eligible for reweighting in the Promoting Interoperability performance category.
• Unlike applications for individuals, groups and virtual groups, an APM Entity’s approved application for performance category weighting will override previously submitted data.

Please note that if an APM Entity doesn’t report for the 2020 performance period (or doesn’t have an approved EUC application), their MIPS eligible clinicians will receive a payment cut in the 2022 payment year.

Additional Resources:

• 2020 MIPS Extreme and Uncontrollable Circumstances Application Resources
• Quality Payment Program COVID-19 Response fact sheet