CMS sent out a final rule regarding MIPS for 2018 on Thursday, November 2nd, 2017.  In this rule Medicare has included information regarding exemptions for areas impacted by recent hurricanes.  Certain counties and parishes in Florida, Texas, Louisiana, Georgia and South Carolina will be automatically exempt from reporting MIPS for year 2017.  Physicians and providers are still allowed to report if they are willing and able, however, for those that cannot they do not have to worry about getting the 4% penalty in year 2019.

Below is the excerpt (page 1174) from the CMS QPP Year 2 Final Rule regarding the exemption   Please note that clinicians that submit data can still potentially earn a positive payment adjustment based on their final performance score.  The Final rule in its entirety can be found at


  1. Regions Impacted by Harvey, Irma, and Maria

We believe the recent Hurricanes Harvey, Irma, and Maria are triggering events for the automatic extreme and uncontrollable circumstance policy we are adopting in this interim final rule with comment period. The regions impacted by these events are defined as a major disaster county, municipal (municipio in Spanish), or county-equivalent by the Federal Emergency Management Agency (FEMA) and are:

  • All 67 counties in Florida.
  • All 159 counties in Georgia. CMS-5522-FC 1175
  • The following parishes of Louisiana; Acadia; Allen; Assumption; Beauregard; Calcasieu; Cameron; De Soto; Iberia; Jefferson Davis; Lafayette; Lafourche; Natchitoches; Plaquemines; Rapides; Red River; Sabine; St. Charles; St. Mary; Vermilion; and Vernon.
  • All 78 municipios in Puerto Rico.
  • The following counties of South Carolina: Allendale; Anderson; Bamberg; Barnwell; Beaufort; Berkeley; Charleston; Colleton; Dorchester; Edgefield; Georgetown; Hampton; Jasper; McCormick; Oconee; and Pickens.
  • The following counties in Texas: Aransas; Austin; Bastrop; Bee; Bexar; Brazoria; Burleson; Caldwell; Calhoun; Chambers; Colorado; Comal; Dallas; Dewitt; Fayette; Fort Bend; Galveston; Goliad; Gonzales; Grimes; Guadalupe; Hardin; Harris; Jackson; Jasper; Jefferson; Jim Wells; Karnes; Kleberg; Lavaca; Lee; Liberty; Madison; Matagorda; Milam; Montgomery; Newton; Nueces; Orange; Polk; Refugio; Sabine; San Augustine; San Jacinto; San Patricio; Tarrant; Travis; Tyler; Victoria; Walker; Waller; Washington; and Wharton.
  • All of the U.S. Virgin Islands.

These lists may continue to be updated. The most current list of impacted areas can be found at