Extraordinary Circumstance Exception

Extraordinary Circumstances Exception Policy

The SNF VBP Program adopted an Extraordinary Circumstances Exception (ECE) policy in the FY 2019 SNF PPS final rule (pages 39280–39281). This policy is intended to allow SNFs to receive relief from Program requirements due to natural disasters or other circumstances beyond the SNF's control that may affect the SNF's ability to provide high-quality health care.

If a SNF can demonstrate that an extraordinary circumstance affected the care that it provided to its patients, and thus affected its subsequent measure performance, CMS will exclude the calendar months during which the SNF was affected by the extraordinary circumstance from measure calculations.

ECE Request Instructions

SNFs must complete an ECE request form, available on QualityNet and in the "Resources" section of this website, and send the completed form to the SNF VBP Program Help Desk at SNFVBP@rti.org within 90 days following the extraordinary circumstance. SNFs must provide the dates and duration of the extraordinary circumstance in their request and include any available evidence of the impact of the extraordinary circumstance on the care that the SNF provided to its patients. This evidence includes, but is not limited to, photographs, media articles, and any other materials that would aid CMS in making its decision. CMS will only consider requests with complete information.

CMS will review exception requests, and at CMS’s discretion, based on its evaluation of the impact of the extraordinary circumstance on the SNF’s care, CMS will respond to the SNF with a decision as quickly as is feasible.

CMS can also grant exceptions to SNFs when it determines that an extraordinary circumstance, such as an act of nature, affects an entire region or locale. If CMS decides to grant an exception to all SNFs in a region or locale, CMS will communicate this decision to affected SNFs.

ECEs’ Effects on SNFs’ Performance Scores

If CMS approves a SNF’s ECE request, CMS will exclude the SNF’s data from measure rate calculations for the calendar months during which the SNF was affected by the extraordinary circumstance.

CMS will continue to score any SNF that receives an ECE on achievement and improvement for any other months during the applicable baseline and/or performance period. For example, if a SNF received an ECE for 6 months of the performance period, CMS will score the SNF on its achievement and improvement during the other 6 months of the performance period.

Resources

• ECE request form