The information below was originally pulled from the Centers for Medicare and Medicaid Services and the American Medical Association.

Due to the ongoing national intravenous (IV) fluid shortage, the Centers for Medicare and Medicaid Services (CMS) will reopen the Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) Application. Physicians will be able to submit an EUC hardship exception application between March 31, 2025, and April 14, 2025, to avoid a MIPS penalty of up to -9% if they were affected by the shortage.

Only applications that cite the shortage as the basis for requesting reweighting under the MIPS EUC exception will be accepted. All other applications submitted for any other reason will be denied.

This hardship exception will apply to the 2024 performance period, which will adjust Medicare payments in 2026. To avoid a MIPS penalty, physicians who were affected by the IV fluid shortage should submit an EUC application requesting reweighting of all four MIPS categories – quality, cost, promoting interoperability, and improvement activities. Note that CMS will not reweight any performance category for which the agency has received data. However, if three performance categories are reweighted to 0% and only one performance category can be scored, then the physician or group will earn a final score equal to the performance threshold and avoid a MIPS penalty. Additionally, because the MIPS cost performance category relies entirely on claims-based measures that do not require submission from physicians or groups, we recommend requesting reweighting of this category if a physician or group needed to conserve IV fluids, use alternatives, restrict access to elective surgery or take any other measures due to the nationwide IV fluid shortage.

CMS will also be extending the MIPS data submission deadline until April 14, 2025, at 8 PM EST. It is important to note that certain clinicians, groups and Alternative Payment Model (APM) entities’ deadline to elect to participate in MIPS – because they are opt-in eligible due to the low-volume threshold or are partially qualifying APM participants (Partial QPs) – is still March 31, 2025 at 8 PM EST.

To apply: 

1. Sign in to the QPP website.
2. Select ‘Exceptions Applications’ on the left-hand navigation.
3. Select ‘Add New Exception’.
4. Select ‘Extreme and Uncontrollable Circumstances Exception’.
5. Complete the application. **

**When the application reopens, you MUST select “National IV Fluid Shortage” as the Event Type and include the impact to your practice in the Event Description. 

If your application is approved, you can still submit data should circumstances change before the submission deadline. For more information on PY2024 MIPS data submission, visit the QPP Resource Library. For questions, contact TMA’s Legal Department at legal@tnmed.org.

The Tennessee Medical Association will follow this topic and provide any updates as they arise.