Consumer Assessment of Healthcare Providers and Systems (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 Appendix H: Vendor Attestation	Form and Instruction	Modified	Available
Form CMS-10450 Appendix F: Vendor Form	Form and Instruction	Modified	Available
Form CMS-10450 Appendix E: CATI Script	Form and Instruction	Modified	Available
Form CMS-10450 Attachment B: Mail Survey	Form	Modified	Missing upstream
CMS-10450 CAHPS for MIPS SS Part A 12.12.2017 clean.docx	Supporting Statement A	Uploaded 2017-12-20	Available
CMS-10450 CAHPS for MIPS SS Part B 12.12.2017 clean.docx	Supporting Statement B	Uploaded 2017-12-20	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227777	CAHPS for MIPS Group Registration		Modified
227776	CAHPS for MIPS Survey Vendor Application	Form and Instruction	Modified	Appendix H: Vendor Attestation
227776	CAHPS for MIPS Survey Vendor Application	Form and Instruction	Modified	Appendix F: Vendor Form
206234	CAHPS for MIPS Survey Beneficiary Participation	Form and Instruction	Modified	Appendix E: CATI Script
206234	CAHPS for MIPS Survey Beneficiary Participation	Form	Modified	Attachment B: Mail Survey
206234	CAHPS for MIPS Survey Beneficiary Participation	Instruction	Modified

ICR Details

OMB Control No: 0938-1222	ICR Reference No: 201712-0938-014
Status: Historical Active	Previous ICR Reference No: 201708-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: 19180
Title: Consumer Assessment of Healthcare Providers and Systems (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: 02/20/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/20/2017
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	04/30/2020
Responses	132,783	0	132,307
Time Burden (Hours)	29,950	0	43,661
Cost Burden (Dollars)	0	0	0

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Abstract: CMS is requesting clearance to implement a revised 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. The CAHPS for MIPS survey counts for one measure towards the MIPS quality performance category, and groups of two or more MIPS eligible clinicians can voluntarily elect to participate in the CAHPS for MIPS survey as one of their six required quality measures as finalized in the CY 2017 Quality Payment Program final rule. The use of a CAHPS survey (including the CAHPS for MIPS survey) would be counted as a high- weighted activity under the improvement activities performance category. We are requesting approval to use a revised, shorter version of the CAHPS for MIPS survey that will maintain or improve reliability while reducing beneficiary burden.

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Authorizing Statute(s): US Code: 42 USC 1395w-4 Name of Law: MACRA of 2015
   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
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-AT13	Final or interim final rulemaking	82 FR 53568	11/16/2017

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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: 3

table that charts list of burden

IC Title	Form No.	Form Name
CAHPS for MIPS Group Registration
CAHPS for MIPS Survey Beneficiary Participation	CMS-10450, CMS-10450	Attachment B: Mail Survey ,   Appendix E: CATI Script
CAHPS for MIPS Survey Vendor Application	CMS-10450, CMS-10450	Appendix F: Vendor Form ,   Appendix H: Vendor 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	132,783	132,307	0	476	0	0
Annual Time Burden (Hours)	29,950	43,661	0	-13,711	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The change in the estimated annual burden for the CAHPS for MIPS survey version 2.0 compared to the CAHPS for MIPS survey in the transition year is 13,771 hours lower than the previously approved the burden estimate for the CAHPS for MIPS survey 1.0 burden. The reduced burden is due to the shortened survey length.

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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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 12/20/2017

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