March 22, 2024: Advocacy Update spotlight on Change Healthcare cyberattack

With the massive impact that the Change Healthcare cyberattack has had on physician practices, the AMA’s advocacy continues at all levels to find workable solutions that allow practices to maintain financial stability while providing timely patient care.

The Centers for Medicare & Medicaid Services (CMS) announced that it is reopening the 2023 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) hardship application for physicians impacted by the cyberattack. In addition, bipartisan members of the House of Representatives recently sent a letter to HHS Secretary Xavier Becerra alerting the administration of the ongoing challenges physicians and patients are continuing to experience as part of the Change Healthcare cyberattack. Read below for more information.

On March 19, the AMA sent a letter (PDF) to the National Association of Medicaid Directors (NAMD) asking that it urge state Medicaid departments to immediately capitalize on the new flexibilities from CMS related to State Plan Amendments (SPAs) for authority to make interim payments to physicians and other health care providers. States should quickly apply for such Medicaid SPAs to assist physician practices serving Medicaid beneficiaries in weathering this crisis.

In addition, the AMA sent a March 11 letter (PDF) to Xavier Becerra, secretary of the U.S. Department of Health and Human Services (HHS), and Julie Su, acting secretary of the U.S. Department of Labor, urging their departments and all health care system partners to take an “all hands on deck” approach to continue supporting physicians and build upon the Change Healthcare/Optum Payment Disruption (CHOPD) Accelerated Payments to Part A Providers and Advance Payments to Part B Suppliers announced on March 9. Additional concerns that the AMA asked these departments to address included:

• Create an inventory of all the health plans that are currently offering advance payments
• Ensure all Medicare Administrative Contractors (MACs) and health plans are accepting paper claims
• Provide more specifics and support for physicians requesting expedited electronic data interchange (EDI) enrollment to switch claims processing clearinghouses
• Encourage the health information technology community to postpone user fees

The AMA sent an additional letter (PDF) on March 8 asking the National Association of Insurance Commissioners to urge its members to take immediate action to protect physician practices from the widespread impact of the Change Healthcare cybersecurity breach and resulting outage.

Based on direct AMA advocacy to the administration (PDF), CMS has now reopened the 2023 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) hardship application due to the Change Healthcare cyberattack. The deadline to apply for an exemption is April 15. The 2023 MIPS EUC hardship exemption is not automatic and requires physicians to apply. Because CMS is reopening the 2023 MIPS EUC Exception Application window in response to the cyberattack, CMS will only approve applications citing this cyberattack as the basis for requesting reweighting under the MIPS EUC Exception. Any applications submitted for reasons outside of the Change Healthcare cyberattack will be denied.

The AMA notes that submission of MIPS data will override the EUC hardship exception. Therefore, if a physician or practice has already submitted data and would like to take advantage of this flexibility, it requires logging into the CMS portal and updating the submission. Individual MIPS eligible clinicians, groups, virtual groups and Alternative Payment Model (APM) Entities participating in MIPS (including Shared Savings Program Accountable Care Organizations) who anticipate being unable to submit data for the 2023 performance year, or complete their data submission, before the extended deadline because of the Change Healthcare cyberattack, can submit a 2023 MIPS EUC Exception Application until 7:00 p.m. Central time on April 15.

Physicians and practices can submit an application to request reweighting for any or all MIPS performance categories. Reweighting of all performance categories will result in avoiding a MIPS penalty of up to -9 percent. If a physician or practice would like to still be scored on the 2023 MIPS Program, the extended deadline to submit data remains April 15.

For more information on the MIPS EUC exception application:

• 2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (PDF)
• QPP Exception Applications

On March 19, Representatives Mariannette Miller-Meeks, MD (R-IA) and Robin Kelly (D-IL), along with 94 bipartisan members of the House of Representatives, sent a letter (PDF) to HHS Secretary Xavier Becerra alerting the administration of the ongoing challenges physicians and patients are continuing to experience as part of the Change Healthcare cyberattack. This letter comes on the heels of advocacy from the AMA related to this issue.

In addition to highlighting the inability of physician practices to file claims and receive prompt payment, the letter urges CMS to clarify why they issued such stringent repayment terms as part of their March 9 announcement permitting advance payments for Part B physicians and other providers. The letter also highlights how individuals are being forced to pay out of pocket for pharmaceuticals and health care services due to the cyberattack, as well as pressed the Department for answers as to how it proposes to safeguard patients from the negative impact of their private health care information being inappropriately disclosed to malicious actors. This letter has been added to the Change Healthcare page of the AMA website, which continues to provide timely updates surrounding ongoing advocacy efforts pertaining to this cyberattack.

The AMA applauds Reps. Miller-Meeks and Kelly for their tremendous bipartisan leadership and will continue to work with members of the House and Senate to ensure expeditious relief from the Change Healthcare cyberattack.

• March 22, 2024: Medicare Payment Reform Advocacy Update
• March 22, 2024: National Advocacy Update
• March 22, 2024: State Advocacy Update