MIPS Extreme and Uncontrollable Circumstances Policy Update

The final deadline to report for the Merit-based Incentive Payment System (MIPS) performance year (PY) 2022 is quickly approaching—March 31, 2023 in fact. But in the event your data reporting has been adversely affected by matters beyond your control, CMS has announced changes to the automatic Extreme and Uncontrollable Circumstances (EUC) exception policy that PTs, OTs, and SLPs should be aware of, and we're sharing those here. 

What is the EUC and why should I care?

MIPS participation has many nuances and requirements, and keeping track of new rules or changes can be challenging. To make matters worse, major disasters and epidemics can make meeting all the requirements overwhelmingly burdensome. In recognition of this, CMS has created the EUC application for MIPS participants to request that certain performance categories be reweighted—essentially enabling them to opt out of some performance categories (if not all) for the performance year. In some instances (or locations), the EUC gets automatically applied; however, automatic exemptions change periodically.

COVID-19 is not considered an automatic EUC for PY 2022.

Since the start of the pandemic, MIPS reporting has been touch-and-go and, in many cases, an automatic exception was applied to MIPS participants heavily impacted by COVID-19—even if prior participation was required. But for the 2022 PY, COVID-19 was not listed under reasons that constitute an automatic MIPS EUC exception. (Even though the public health emergency (PHE) is still ongoing.) 

So, rehab therapists who feel that COVID-19 disrupted their ability to treat patients last year, thus negatively impacting their MIPS score, can still apply for a PY 2022 EUC exception until March 3, 2023. 

What about for PY 2023?

The same can be said for PY 2023: COVID-19 is not currently listed as cause for automatic EUC exception. Therefore, clinicians who are worried they will receive a subpar MIPS score due to implications from COVID-19 in PY 2023 can apply for an EUC exception. The EUC application period for PY 2023 opens in the spring of 2023 and closes at 8:00 PM ET on January 2, 2024.

How do I apply for an EUC?

Under normal circumstances, the deadline for EUC exception applications is at the beginning of the new year, but CMS recently announced the due date for PY 2022 MIPS EUC exception applications has been extended to March 3, 2023. 

So if you are in need of an exception, let's discuss what criteria would get you qualified. Via the Quality Payment Program (QPP) site, circumstances that a MIPS EUC exception would apply include:

• An inability to collect MIPS data necessary for submittal;
• Submittal of data is unable to be done for an increased length of time (e.g., three months of missing data); or
• Normal processes affecting cost measures and other administrative measures have been greatly disrupted.

To apply for an EUC, you’ll start with creating a HARP account on the QPP website—which is something MIPS participants should already have and be familiar with. HARP stands for HCQIS Access Roles and Profile, and it is used to ensure secure and confidential access to the MIPS QPP system. Once you have created an account, follow these steps to get your EUC exception application filed and completed:

1. Sign in to the QPP website.
2. Select “Exceptions Applications” in the navigation bar on the left side of the page.
3. Select “Add New Exception.”
4. Select “Extreme and Uncontrollable Circumstances Exception.”
5. Complete and submit the application. 

After completion you will receive an email notifying you of an approval or denial. Can’t wait? Log into your QPP profile to view your status. 

Be warned: If you do choose to submit any category data for the 2023 performance year, it will automatically override the EUC exception. So, don’t submit any data for 2023 unless you truly want to be scored.

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When is an automatic EUC exception currently applied?

Wondering if you already qualify for an automatic exception? CMS sends out a list of current qualifying events via the QPP listserv, which you can sign up for at the bottom of the QPP site. CMS will also update this fact sheet to identify new events that have been added to the automatic exemptions list.

For current FEMA-designated disaster areas, CMS identifies the following four regions that qualify for automatic exceptions: 

• Kentucky: DR-4663-KY
• New Mexico: DR-4652-NM
• Puerto Rico: DR-4671-PR
• Florida: EM-3584-FL 

CMS also states that group and virtual group MIPS participants are not included in automatic EUC exceptions, so if you fall into one of those two categories and are seeking an EUC exception, your group will need to apply for one.

In the ever-changing landscape that is the US healthcare system, it’s nice to see CMS acknowledge—albeit occasionally—that certain circumstances are indeed beyond a provider’s control. However, we do realize that these allowances aren’t always widely communicated. So, if you have any further questions about MIPS changes, be sure to check out our updated MIPS guide. Or, drop us a line in the comment section below.