Electronic Health Record
demonstration. This demonstration is a high-priority Administration
of this initiative. The purpose of this demonstration project is to
reward the delivery of high-quality care supported by the adoption
and use of electronic health records in small to medium-sized
primary care physician practices. While this initiative is separate
and distinct from the Medicare Care Management Performance (MCMP)
Demonstration, it expands upon the foundation created by the MCMP
Demonstration, which was mandated by Section 649 of the Medicare
Prescription Drug, Improvement and Modernization Act of 2003. The
electronic health record demonstration will be operational for a
5-year period and will be operated under section 402 demonstration
waiver authority. The information to be obtained as part of the
application form is necessary to document basic information for
physician practices that intend to participate in this
demonstration initiative. This information will be used to
establish that the practices meet basic eligibility requirements
for participation in this initiative. The application form requests
basic physician office information (e.g., number of physicians in
the practice, specialties, organizational structure, Medicare
Provider Identification Number, tax identification number, contact
information, etc. Practices that apply will be expected to sign a
data sharing consent form that will accompany the form. It is
expected that up to 2,400 application forms will be submitted by
physician practices in 12 states for subsequent randomization to
treatment and control groups.
PL:
Pub.L. 108 - 173 649 Name of Law: Medicare Care Management
Performance (MCMP) Demonstration
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Form CMS-10165 Electronic Health Record Demonstration
Description of Changes to Form_REVISEDFINAL_61708.doc
Electronic Health Record Demonstration