Extraordinary Circumstances 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) and expanded this policy in the FY 2025 SNF PPS final rule. The ECE policy allows 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 or the SNF’s ability to report required measure data by specified deadlines.

If a SNF can demonstrate that an extraordinary circumstance affected the care that it provided to its patients or its ability to report data, 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

In the FY 2025 SNF PPS final rule CMS updated the instructions for requesting an ECE for the SNF VBP Program beginning with the FY 2025 Program year. Rather than submitting a completed ECE Request Form, SNFs may request an ECE by sending an email with the subject line “SNF VBP Extraordinary Circumstances Exception Request” to the SNF VBP Program Help Desk at SNFVBP@rti.org with the following information: 

1. The SNF’s CMS Certification Number (CCN)
2. The SNF’s business name and business address 
3. Contact information for the SNF’s CEO or CEO-designated personnel, including all applicable names, email addresses, telephone numbers, and the SNF’s physical mailing address (not a PO Box)
4. A description of the event, including the dates and duration of the extraordinary circumstance
5. Available evidence of the impact of the extraordinary circumstance on the care the SNF provided to its residents or the SNF’s ability to report SNF VBP Program measure data, including, but not limited to, photographs, media articles, and any other materials that would aid CMS in determining whether to grant the ECE 
6. A date when the SNF believes it will again be able to fully comply with the SNF VBP Program’s requirements and a justification for the proposed date.

SNFs must submit an ECE request within 90 days of the date that the extraordinary circumstance occurred. 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 and/or its ability to report data, 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.