CMS Updates Healthcare Quality Reporting Exceptions in Response to COVID-19 Crisis

April 6, 2020

For updates on this topic, please see our alert “CMS Continues to Increase Flexibility in Quality Reporting Requirements” (May 8, 2020).

As discussed in a previous alert from March 24, 2020, due to the 2019 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 has issued updated exceptions and extensions, supplementing the earlier announcement and providing additional guidance to healthcare providers with regard to the exceptions and extensions.

As discussed in McGuireWoods’ earlier alert, for Merit-Based Incentive Payment System (MIPS) reporting deadlines scheduled for March 2020, CMS is implementing its “automatic extreme and uncontrollable circumstances policy.” This policy was established to reweight and, in certain circumstances, provide a neutral payment adjustment if there are extreme and uncontrollable situations, such as natural disasters and emergencies. Accordingly, CMS is delaying reporting deadlines and providing neutral payment adjustments for the 2021 MIPS payment year. Specifically, MIPS-eligible clinicians will have all four of the performance categories automatically weighted at zero percent and will receive a MIPS final score that results in a neutral payment adjustment for the 2021 MIPS payment year. If, however, eligible clinicians submit data on two or more MIPS performance categories by April 30, 2020, even when they are not obligated to do so, they will be scored on those performance categories and the 2019 MIPS score will determine their 2021 MIPS payment adjustment.

Furthermore, in the event that MIPS-eligible clinicians in an Alternative Payment Model (APM) Entity do not provide CMS with data for the “Promoting Interoperability” or “Quality” performance categories because of the COVID-19 pandemic, then the “Cost” performance category will be weighted at zero percent and the “Improvement Activities” performance category will be scored as it typically would be.  There will be a neutral MIPS payment adjustment for the provider, however, if just one performance category is scored. CMS has also published a fact sheet with more information related to the 2019 Quality Payment Program COVID-19 Response.

CMS is also granting exceptions to the Quality Reporting Program (QRP) reporting requirements for acute care hospitals, prospective payment system-exempt cancer hospitals, inpatient psychiatric facilities, skilled nursing facilities, home health agencies, hospices, inpatient rehabilitation facilities, long-term care hospitals, ambulatory surgical centers and end-stage renal disease (dialysis) facilities.  Many of these providers are excepted from reporting for Q4 (Oct. 1-Dec. 31) of 2019 as well as Q1 (Jan. 1-March 31) and Q2 (April 1-June 30) of 2020, though the exact exception is program-specific.  


CMS notes that it is closely monitoring the situation for potential adjustments and will update exception lists, exempted reporting periods and submission deadlines accordingly as events occur. McGuireWoods 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.