1. (a) General. CMS—

   1. (1) Applies determinations made under the Quality Payment Program with respect to whether an extreme and uncontrollable circumstance has occurred and the affected area during the PY; and
   2. (2) Has sole discretion to determine the period during which an extreme and uncontrollable circumstance occurred and the percentage of attributed patients residing in affected areas.

2. (b) Impact on payments. In the event of an extreme and uncontrollable circumstance, as described in paragraph (a) of this section, CMS may adjust the magnitude and direction of the IOTA participant's upside or downside risk payment, if applicable, prior to recoupment or payment, if the IOTA participant is participating in the IOTA Model when CMS has declared such an emergency period. CMS may determine any adjustment made based in part on the following:

   1. (1) The percentage of total months during the PY affected by the extreme and uncontrollable circumstance.
   2. (2) The percentage of attributed patients who reside in an area affected by the extreme and uncontrollable circumstance.

[89 FR 96445, Dec. 4, 2024, as amended at 91 FR 32871, June 1, 2026]