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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10450 CAHPS for MIPS Survey	Form and Instruction	Modified	Available
Survey Development Report PUBLIC 2012_11_6 FINAL.pdf	Supplementary Document	Uploaded 2017-04-21	Available
CAHPS for MIPS SS Part B - Passback_CAHPS 4-5-17 clean.docx	Supporting Statement B	Uploaded 2017-04-21	Available
CAHPS for MIPS SS Part A - Passback_CAHPS 4-5-17 clean.docx	Supporting Statement A	Uploaded 2017-04-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206234	CAHPS for MIPS Survey	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1222	ICR Reference No: 201611-0938-001
Status: Historical Active	Previous ICR Reference No: 201606-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: 19180
Title: CAHPS Survey for the Merit-Based Incentive Payment System (MIPS) (CMS-10450)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/21/2017
	Date Received in OIRA: 11/02/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2020	36 Months From Approved	04/30/2017
Responses	132,307	0	117,300
Time Burden (Hours)	43,661	0	39,530
Cost Burden (Dollars)	0	0	0

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Abstract: 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.

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

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

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS69	Final or interim final rulemaking	81 FR 77008	11/04/2016

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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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 for MIPS Survey	CMS-10450, CMS-10450, CMS-10450	CAHPS for MIPS Survey Script ,   CAHPS for MIPS Survey ,   CAHPS for MIPS Attestation

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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	132,307	117,300	0	15,007	0	0
Annual Time Burden (Hours)	43,661	39,530	0	4,131	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The changes in the estimated annual burden for CAHPS for MIPS is 4,131 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.

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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: 11/02/2016

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