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) announced 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 expected.
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 following programs:
|Provider Reporting Programs
|Hospital Reporting Programs
|Post-Acute Care Reporting Programs
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.
McGuireWoods has published additional thought leadership related to how companies across various industries can address crucial coronavirus-related business and legal issues, and the firm’s COVID-19 Response Team stands ready to help clients navigate urgent and evolving legal and business issues arising from the novel coronavirus pandemic.