CAHPS Survey for the Merit-Based Incentive Payment System (MIPS) (CMS-10450)

ICR 201606-0938-002

OMB: 0938-1222

Federal Form Document

Forms and Documents
Form and Instruction
Supporting Statement B
Supporting Statement A
IC Document Collections
206234 Modified
ICR Details
0938-1222 201606-0938-002
Historical Inactive 201303-0938-016
HHS/CMS 19180
CAHPS Survey for the Merit-Based Incentive Payment System (MIPS) (CMS-10450)
Revision of a currently approved collection   No
Comment filed on proposed rule and continue 09/22/2016
Retrieve Notice of Action (NOA) 06/07/2016
OMB files this comment in accordance with 5 CFR 1320.11( c ). This OMB action is not an approval to conduct or sponsor an information collection under the Paperwork Reduction Act of 1995. This action has no effect on any current approvals. If OMB has assigned this ICR a new OMB Control Number, the OMB Control Number will not appear in the active inventory. For future submissions of this information collection, reference the OMB Control Number provided. OMB is withholding approval at this time. Prior to publication of the final rule, the agency should provide a summary of any comments related to the information collection and their response, including any changes made to the ICR as a result of comments. In addition, the agency must enter the correct burden estimates.
  Inventory as of this Action Requested Previously Approved
02/28/2017 36 Months From Approved 04/30/2017
117,300 0 117,300
39,530 0 39,530
0 0 0

CMS is requesting clearance to implement the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey for the Merit-based Incentive Payment System (MIPS). Section 1848(q) of the Social Security Act, as amended by section 101 of the Medicare Access and CHIP Reauthorization Act of 2015, authorizes the establishment of the MIPS for eligible clinicians. In the MIPS Notice of Proposed Rule Making (NPRM), we propose to allow registered groups of two or more MIPS eligible clinicians to voluntarily elect to participate in the CAHPS for MIPS survey. The CAHPS for MIPS survey would count as one cross-cutting and/or a patient experience measure, and the group would be required to submit at least five other measures through one other data submission mechanisms. We propose the data collected on the CAHPS for MIPS survey measures would be transmitted to CMS via a CMS-approved survey vendor.

US Code: 42 USC 1395w-4 Name of Law: MACRA of 2015
   PL: Pub.L. 111 - 148 10331 Name of Law: Affordable Care Act
PL: Pub.L. 111 - 148 10331 Name of Law: Affordable Care Act
US Code: 42 USC 1395w-4 Name of Law: MACRA of 2015

0938-AS69 Proposed rulemaking 81 FR 28162 05/09/2016


IC Title Form No. Form Name
CAHPS for MIPS Survey CMS-10450, CMS-10450, CMS-10450 CAHPS for MIPS Survey ,   CAHPS for MIPS Survey Script ,   CAHPS for MIPS Attestation

Miscellaneous Actions
The changes in the estimated annual burden for CAHPS for MIPS is 627 hours higher than the previously approved the burden estimate for the CAHPS for PQRS burden. The change in the burden is the result of an increase in the number of groups reporting CAHPS patient experience measures over time.

Yes Part B of Supporting Statement
Denise King 410 786-1013 [email protected]


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.

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