CAHPS Survey for Physician Quality Reporting

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10450 CAHPS Survey for Physician Quality Reporting	Form and Instruction	New	Repair queued
ACO CAHPS Year 1 Survey Development Report_FINAL.PDF	Supplementary Document	Uploaded 2014-02-12	Available
PQRS Data Adjustments 2014-2-7.docx	Supplementary Document	Uploaded 2014-02-12	Available
CGCAHPS_doc.docx	Supplementary Document	Uploaded 2014-02-12	Available
Y1 ACO Report Template 2013_11_13.pdf	Supplementary Document	Uploaded 2014-02-12	Available
Survey Development Report PUBLIC 2012_11_6 FINAL.PDF	Supplementary Document	Uploaded 2014-02-12	Available
CMS-10450 Supporting Statement B 2012-10-19.docx	Supporting Statement B	Uploaded 2013-03-22	Available
PQRS CAHPS Response to Public Comments_final.doc	Supplementary Document	Uploaded 2013-03-22	Available
._508 Attachment 2 PQRS OMB Survey Cover Letters 2012-10-19.docx	Supplementary Document	Uploaded 2013-03-22	Repair queued
508 PQRS OMB Supporting Statement A 2012-12-10.docx	Supporting Statement A	Uploaded 2013-03-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206234	CAHPS Survey for Physician Quality Reporting	Form and Instruction	New

ICR Details

OMB Control No: 0938-1222	ICR Reference No: 201303-0938-016
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 19180
Title: CAHPS Survey for Physician Quality Reporting
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/12/2014
	Date Received in OIRA: 03/22/2013
Terms of Clearance: Approved consistent with the submission of supplemental documents from CMS clarifying non-response bias adjustments and prospective display formats for data that will be collected under this control number. CMS will revise the package in future to reflect the final display formats of information which will be publicly posted associated with this collection.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2017	36 Months From Approved
Responses	117,300	0	0
Time Burden (Hours)	39,530	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Physician Quality Reporting System (Physician Quality Reporting) is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals. The program provides an incentive payment to practices with eligible professionals (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]) who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). Beginning in 2015, the program also applies a payment adjustment to eligible professionals who do not satisfactorily report data on quality measures for covered professional services. The Physician Quality Reporting System is mandated by federal legislation. The Affordable Care Act makes a number of changes to the Physician Quality Reporting System, including authorizing incentive payments through 2014 and requiring a penalty, beginning in 2015, for eligible professionals who do not satisfactorily report. The Affordable Care Act also authorizes an additional 0.5 percent incentive for 2011 through 2014 for eligible professionals who satisfactorily report and more frequently than is required to qualify for or maintain board certification status participates in a Maintenance of Certification Program for a year and successfully completes a qualified Maintenance of Certification Program practice assessment for such year.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 10331 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 10331 Name of Law: Affordable Care Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 73032	12/06/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 17676	03/22/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
CAHPS Survey for Physician Quality Reporting	CMS-10450	CAHPS Suvery

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	117,300	0	117,300	0	0	0
Annual Time Burden (Hours)	39,530	0	39,530	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $2,120,324

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/22/2013

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