Extensions and Exemption Requests
About this Page
This webpage provides information on CMS’s HQRP Exemption and Extension Policy for Extraordinary Circumstances. This policy applies to both the Hospice Item Set (HIS) and Hospice Consumer Assessment of Healthcare Providers and Systems (Hospice CAHPS®) survey.
This webpage provides information on two aspects of this general Exemption and Extension for Extraordinary Circumstances policy:
- Provider-initiated requests for exemption or extension for extraordinary circumstances
- CMS-initiated waivers for exemption or extension for extraordinary circumstances that are based on FEMA designated disaster or federally initiated public health emergency.
For additional assistance, hospices may submit questions related to the extensions or exemptions requirements to the following email address: HospiceQRPReconsiderations@cms.hhs.gov.
Although hospice providers are required to submit HIS and CAHPS® data to CMS to comply with HQRP requirements, CMS recognizes that there are instances where an extraordinary or extenuating circumstance beyond the hospice’s control (e.g., natural disasters) may delay or prevent submission of required data.
CMS does not want the extraordinary or extenuating circumstance to unduly increase provider burden, nor does CMS want to negatively impact a hospice provider’s annual payment update (APU) and compliance with HQRP requirements during this time. In the FY 2018 Hospice Final Rule, CMS finalized the Exemption and Extension for Extraordinary Circumstances policy, (82 FR 36671).
This policy consists of two parts:
- Provider-initiated requests for exemption or extension for extraordinary circumstances: if a hospice provider experiences an extraordinary circumstance, they can initiate a request for extension or exemption.The request must be initiated within 90 days of the extraordinary circumstance event and it must be sent to CMS via email following the instructions below.
- CMS-initiated waivers for exemption or extension for extraordinary circumstances: when a disaster, including pandemics a large geographic area or large number of hospice providers, CMS can automatically grant an exemption or extension groups of affected providers. In CMS-initiated waivers, providers do not need to take any action to be granted an exemption or extension. CMS-initiated waivers are communicated to providers via the communication channels noted below.
When an extension or exemption is granted (either through the provider-initiated request or the CMS-initiated waiver), a hospice will not incur payment reduction penalties for failure to comply with the requirements of the HQRP, for the time period for which the extension or exemption was granted.
Note that the Exemption and Extension for Extraordinary Circumstances is different from the CAHPS® size and newness exemptions; for more information on CAHPS size and newness exemptions, please see the Hospice CAHPS® portion of this webpage.
Disasters, including pandemics, preventing timely submission of quality data. A disaster may be widespread or affect multiple structures or isolated and affect a single site only.
Data submission deadline extended. If granted an extension, the hospice is still responsible for submitting data collected during the timeframe in question; the extension allows the provider to submit the data “late” (30-45 days past the deadline) for a specified timeframe, without any negative impact on HQRP compliance/APU.
Data submission for HIS and/or CAHPS® waived for a specified time period. With an exemption, the hospice is exempted from data submission entirely for a specified time period, without any impact on HQRP compliance/APU.
Requesting a Provider-initiated Exemption or Extension Request
The HQRP does not have a specific extension or exemption request form. Instead, hospice providers are required to submit an email request within 90 calendar days of the date the extraordinary circumstance occurred.
How to Submit a Provider-Initiated Exemption or Extension Request
Extension or exemption requests and supporting documentation must be submitted via email with the subject line that contains the text: “ACA 3004 Extension and Exemption Request” and the Hospice CCN (e.g., ACA 3004 Extension and Exemption Request, CCN = XXXXXX) to the following email address: HospiceQRPReconsiderations@cms.hhs.gov.
The request must include the following information:
- The Hospice CMS Certification Number (CCN),
- The Hospice business name,
- The Hospice business address,
- The Administrator contact or designee representative information, including name, email address, telephone number, and physical mailing address; and
- The reason(s) for requesting an extension or exemption,
- Time period the hospice wishes to request an extension or exemption; and
- Identify which reporting requirement the extension/exemption is being requested for (i.e., HIS, CAHPS®, or both).
The request for extension or exemption must be accompanied by supporting documentation demonstrating need. CMS will be unable to review any request that fails to provide the necessary documentation along with the request. Supporting documentation must include the following:
- Proof of an extraordinary circumstances beyond the hospices control, (for example disasters), may be in the form of a news article, pictures, or other documentation attesting to the incident,
- Includes Dates of occurrence; and
- Other documentation that may support the rationale for seeking extension or exemption.
- Key is that the provider must show how the extraordinary circumstances beyond the hospice’s control impacts the hospice’s ability to submit quality data timely.
- CMS will provide written acknowledgment upon receipt of the request to the Administrator or Administrator designee contact provided in the request.
- CMS will determine whether the evidence submitted supports the extension or exemption request. The determination will be made based solely on the documentation provided. CMS will not contact the hospice to request additional information or to clarify incomplete or inconclusive information.
- CMS will provide written notification of the decision to the Administrator or Administrator designee indicated in the request. The response usually occurs within 30 days of receipt of the request.
If clear evidence to support the need for an extension or exemption exists, CMS will provide the extension or exemption for a determined period of time. If no clear evidence to support the need is given, the request will be denied.
Please ensure that no protected health information (PHI) or personally identifiable information (PII) is included in the documentation being submitted for review.
Communicating CMS-initiated Waivers
If CMS grants a waiver, CMS will communicate the decision through routine channels to hospices and vendors, including, but not limited to, Open Door Forums, ENews and notices on the CMS Hospice Quality Reporting website (direct link): /Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting.
For disasters like hurricanes or pandemic, CMS will post updates on the CMS Emergencies webpage page. We recommend you check the CMS Emergency webpage frequently for updates.
Special Circumstances for Hospice Providers
CMS waivers are often made at the agency-level, for a variety of care settings at once; thus, CMS-initiated waiver language communicated through the channels above may not be specific to hospice agencies.
CMS realizes that hospice care delivery is unique compared to other care settings. For example, a hospice may have a business office located in one state, but provide services in another state. In these instances, for the purposes of the HQRP, it is CMS’s intent for waivers to apply to the hospice’s service area, not their business address, corporate office, etc. Thus, if CMS grants a waiver for an affected area, if your hospice agency serves patients in that area, you can assume the waiver applies to your agency. If your agency is later found non-compliant due to late or missing data for the time period of the disaster, CMS would encourage your agency to apply for Reconsideration.
Hospice QRP: Disaster Protocol
Hospice providers affected by disasters in counties that are identified through the Federal Emergency Management Agency (FEMA) as “Designated Areas” will be provided guidance and further information via this webpage with respect to data submission requirements as it becomes available.
In addition, details and materials are also available on the CMS Emergency webpage.
Please note: designated areas may be updated to add affected areas by disasters. Please continue to check back frequently for updates.