For updates on this topic, please see our alerts "CMS Updates Healthcare Quality Reporting Exceptions in Response to COVID-19 Crisis" (April 6) and "CMS Continues to
Increase Flexibility in Quality Reporting Requirements" (May 8, 2020).
Due to the novel coronavirus (COVID-19) pandemic, the Centers for Medicare
& Medicaid Services (CMS)
it would temporarily ease quality reporting requirements for clinicians,
providers and healthcare facilities participating in Medicare quality
reporting programs. CMS announced both exceptions and extensions for
upcoming reporting and data submission requirements.
Generally, for provider reporting deadlines scheduled for March 2020 (e.g.,
the Merit-Based Incentive Payment System, or MIPS), CMS is delaying the
reporting period for a month. In addition, if the deadline was scheduled
for April or May 2020 (including the above-mentioned delayed provider
period), such submission will be optional and at the provider’s or
facility’s discretion. Third, in general, for services provided Jan. 1
through June 30, 2020, CMS will not require reporting or use data from this
period to calculate the Medicare quality reporting and value-based
purchasing programs for future payment years.
Specifically, for provider reporting programs such as MIPS, the deadline
was extended from March 31, 2020, to April 30, 2020, but a MIPS provider
who does not submit MIPS data by April 30, 2020, will simply receive a
neutral payment adjustment for the 2021 MIPS payment year. With respect to
2020 reporting data, CMS is considering its options. More guidance is
Further, specifically for the hospital and post-acute care reporting
programs, the data submissions for fourth quarter 2019 (Oct. 1 through Dec.
31, 2019) are now optional. If a hospital or post-acute care enrolled
provider decides to submit fourth-quarter data, CMS will use it to
determine performance and payment adjustments under the applicable program.
However, if a hospital program opts not to provide fourth-quarter data or
is unable to do so, then 2019 performance will be determined based upon
information from Jan. 1 - Sept. 1, 2019.
With respect to 2020 reporting periods, CMS does not intend to use data for
the period Jan. 1 through June 30, 2020, for hospital or post-acute care
program performance or payment programs. No data
needs to be submitted for this period. However,
additional changes are being made
for special situations, such as the Hospital-Acquired Condition Reduction
Program, the Hospital Value-Based Purchasing Program, the Home Health and
Hospice Consumer Assessment of Healthcare Providers and Systems and the
Skilled Nursing Facility Value-Based Purchasing Program. Indeed, in cases
like home health and hospice, CMS has already stated the non-reporting
period will extend through Sept. 30, 2020.
To be clear, CMS is applying this extension and waiver policy to the
Provider Reporting Programs
Hospital Reporting Programs
Post-Acute Care Reporting Programs
Ambulatory Surgical Center Quality
CrownWeb National ESRD Patient Registry and Quality
Measure Reporting System
End-Stage Renal Disease (ESRD) Quality Incentive Program
Hospital-Acquired Condition Reduction Program
Hospital Inpatient Quality Reporting Program
Hospital Outpatient Quality Reporting Program
Hospital Readmissions Reduction Program
Hospital Value-Based Purchasing Program
Inpatient Psychiatric Facility Quality Reporting Program
PPS-Exempt Cancer Hospital Quality Reporting Program
Promoting Interoperability Program for Eligible Hospitals
and Critical Access Hospitals
Home Health Quality Reporting Program
Hospice Quality Reporting Program
Inpatient Rehabilitation Facility Quality Reporting
Long Term Care Hospital Quality Reporting Program
Skilled Nursing Facility Quality Reporting Program
Skilled Nursing Facility Value-Based Purchasing Program
CMS acknowledges that these are unprecedented times and any information
submitted during the COVID-19 pandemic may not accurately reflect the
providers’ actual performance with respect to costs, readmissions and
patient experience. Therefore, CMS does not want to penalize or otherwise
harm organizations that do not submit data at this time. Further, CMS notes
that “cutting bureaucratic red tape” will allow the healthcare system to
focus resources on patient care.
The situation is evolving rapidly. We will continue to monitor any
additional CMS developments and guidance related to reporting and other
requirements for healthcare providers. Please contact the authors for more
information regarding regulatory responses to the COVID-19 pandemic.
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