Quality Payment Program: 2019 Performance Period Suppressed MIPS Quality Measures

In the Calendar Year (CY) 2019 Physician Fee Schedule Final Rule (83 FR 59847), the Centers for Medicare & Medicaid Services (CMS) established a policy that provides for the suppression of measures in certain circumstances. Starting with the 2019 performance period, for measures significantly impacted by clinical guideline changes or other changes where we believe that adherence to guidelines in the existing measures could result in patient harm or otherwise cause misleading results as to what is measured as good quality of care, we will reduce the denominator of available measure achievement points for the quality performance category by 10 points for each impacted measure that is submitted by MIPS eligible clinicians and groups. Such policy will “hold harmless” any clinician or group submitting data on a suppressed measure.

The measures identified below have been suppressed under § 414.1380(b)(1)(vii), which is limited to the 2019 MIPS performance period. In order for the impacted measures to reflect the clinical guideline changes, CMS updates the impacted measures through the rulemaking process.

2019 Quality Measure Suppression List
Quality Measure Number/Title	Collection Type Impacted	Guideline Changes and Suppression Rationale
Measure 69: Hematology: Multiple Myeloma: Treatment with Bisphosphonates	MIPS CQM	Guideline Change Impact: The updated National Comprehensive Cancer Network (NCCN) Guidelines for Multiple Myeloma recommend bisphosphonates (Category 1 Recommendation) or denosumab for all patients receiving myeloma therapy for symptomatic disease regardless of documented bone disease. Denosumab is preferred by the NCCN Panel in patients with renal disease. (NCCN, 2020). For the MIPS 2019 performance period, eligible clinicians may utilize the denominator exception of a medical reason for the use of denosumab, as previous guidelines recommended bisphosphonates for all patients receiving myeloma therapy for symptomatic disease, not including the option of prescribing denosumab. Suppression Rationale: The clinical guideline change that supported the use of denosumab was made between rulemaking cycles and as a result, the updated clinical guideline is not compatible with the existing guidance in the 2019 measure specification, which could cause misleading results as to what is measured as good quality of care. Therefore, this measure will be suppressed
Measure 110: Preventive Care and Screening: Influenza Immunization	Medicare Part B Claims, MIPS CQM, eCQM, CMS Web Interface	Guideline Change Impact: In 2018, the Centers of Disease Control (CDC)/Advisory Committee on Immunization Practice (ACIP) updated clinical guidelines to include the recommendation that live attenuated influenza virus was acceptable for the 2018-2019 influenza season. The 2019 measure specification states the following: As a result of updated CDC/ACIP guidelines which include the interim recommendation that live attenuated influenza vaccine (LAIV) should not be used due to low effectiveness against influenza A (H1N1) pdm09 in the United States during the 2013-14 and 2015-16 seasons, LAIV or intranasal flu vaccine is no longer an option for numerator eligibility. Suppression Rationale: The clinical guideline change that supported the use of LAIV for the 2018-2019 influenza season was made between rulemaking cycles and as a result, the updated clinical guideline is not compatible with the existing guidance in the 2019 measure specification. The 2019 measure specification includes guidance that does not include LAIV and could cause misleading results as to what is measured as good quality of care. Therefore, this measure will be suppressed.
Measure 450: Trastuzumab Received By Patients With AJCC Stage I (T1c) – III And HER2 Positive Breast Cancer Receiving Adjuvant Chemotherapy	MIPS CQM	Guideline Change Impact: In January of 2019, the Food & Drug Administration (FDA) approved biosimilar drugs to trastuzumab. Suppression Rationale: For the 2019 performance period, guidance for the use of biosimilar drugs to report as a denominator exception was not included as an available option within the measure specification. The clinical guideline change that supported the use of other biosimilar drugs as a treatment for AJCC Stage I (T1c) – III and HER2 Positive Breast Cancer was made between rulemaking cycles and as a result, the updated clinical guideline is not compatible with the existing guidance in the 2019 measure specification, which could cause misleading results as to what is measured as good quality of care. Therefore, this measure will be suppressed.

Please direct any questions related to the measures suppressed for the 2019 performance period to the Quality Payment Program Service Center at QPP@cms.hhs.gov.

Daily COVID-19 News Alert

As part of the ongoing White House Task Force efforts taken in response to coronavirus disease 2019 (COVID-19), following is a summary of recent Centers for Medicare & Medicaid Services (CMS) actions. To keep up with the important Task Force work being done in response to COVID-19, click here www.coronavirus.gov. For information specific to CMS, please visit the CMS News Room and Current Emergencies Website. CMS updates these resources on an ongoing basis throughout the day; the information below is current as of May 15, 2020 at 12:00 p.m. ET.

Deadline Approaching: Notification Requirements of Confirmed and Suspected COVID-19 Cases Among Nursing Home Residents and Staff

On April 19, CMS announced the agency will be requiring facilities to report COVID-19 information to the CDC and to families. Within three weeks of that announcement, on April 30, CMS issued an Interim Final Rule with Comment Period with new regulatory requirements. With the new regulatory requirements, nursing homes are required to report the first week of data to the CDC beginning May 8 but no later than May 17. For the first time, all 15,000 nursing homes will be reporting this data directly to the CDC through its reporting tool.

In order to report, facilities must enroll in the CDC’s National Healthcare Safety Network (NHSN). Information on how to enroll is available here. As nursing homes report this data to the CDC, CMS will be taking swift action and publicly posting this information so all Americans have access to accurate and timely information on COVID-19 in nursing homes. More information on the CDC’s NHSN COVID-19 module can be found here.

CMS Releases Nursing Home Toolkit with Best Practices and Additional Resources

CMS released a new toolkit developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to these facilities. These additional resources will help in the fight against the COVID-19 pandemic within nursing homes. The toolkit builds on previous actions taken by CMS, which provide a wide range of tools and guidance to states, healthcare providers and others during the public health emergency. The toolkit is comprised of best practices from a variety of front line health care providers, Governors’ COVID-19 task forces, associations and other organizations, and experts, and is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.

Press Release

Toolkit

Trump Administration Announces Call for Nominations for Nursing Home Commission

CMS announced a call for nominations for the new contractor-led Coronavirus Commission on Safety and Quality in Nursing Homes. The commission’s work will build on the Trump Administration’s long history of decisive actions to protect nursing home residents. The commission will conduct a comprehensive assessment of the overall response to the COVID-19 pandemic in nursing homes and will inform immediate and future actions to safeguard the health and quality of life for an especially vulnerable population of Americans.

Press Release

Nursing Home Commission Nominations

CMS Outlines Medicaid Managed Care Options in Responding to COVID-19

CMS released a new Center for Medicaid and CHIP Services Informational Bulletin (CIB) that provides states guidance on how to temporarily modify their Medicaid managed care contracts to address the impact of the COVID-19 public health emergency. The guidance provides several options that states can consider to adjust provider payment methodologies and capitation rates within Medicaid managed care contracts while preserving systems of care and access to services for Medicaid beneficiaries.

Informational Bulletin

CMS Gives States Additional Flexibility to Address Coronavirus Pandemic

CMS has approved over 190 requests for state relief in response to the COVID-19 pandemic, including recent approvals for California, Georgia, Indiana, Minnesota, Missouri, New Mexico, Ohio, and Rhode Island. These approvals help to ensure that states have the tools they need to combat COVID-19. This is done through a wide variety of waivers, amendments, and Medicaid state plan flexibilities, including support for programs that care for the elderly and people with disabilities. CMS also developed a toolkit to expedite the application and review of each request and has approved these requests in record time. These approved flexibilities support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.

Section 1135 Waivers

Section 1115(a) Waivers

1915(c) Waiver Appendix K Amendments

Medicaid State Plan Amendments

CHIP State Plan Amendments