Quality Payment Program/Merit-Based Incentive Payment System (MIPS) (CMS-10621)

Forms and Documents

Document Name	Status
Form CMS-10621 414.1330 (Quality Performance Category) Call for Measures Form and Instruction	Unchanged
Form CMS-10621 414.1375 Advancing Care Information Performance Category - Call for Measures Form and Instruction	Unchanged
Form CMS-10621 ?414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process Form and Instruction	Modified
CMS-10621 non-substantive change justification.docx Justification for No Material/Nonsubstantive Change	2018-07-30
CMS-10621 MIPS CY 2018 Supporting Statement Part B 11-17-17.doc Supporting Statement B	2017-11-17
CMS-10621 MIPS CY 2018 SS part A Final Rule 20171227 clean final.docx Supporting Statement A	2018-01-09

IC Document Collections

IC ID	Document Title	Status
229086	414.1330 (Quality Performance Category) Call for Measures Form and Instruction	Unchanged
229075	414.1445 Other Payer Advanced APM Determininations: Medicaid Specific Clinician Initiated Process	Unchanged
229074	414.1375 Advancing Care Information Performance Category - Call for Measures Form and Instruction	Unchanged
227511	?414.1395 (Physician Compare) Opt Out for Voluntary Participants	Unchanged
227509	?414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process Form and Instruction	Modified
227507	?414.1360 (Improvement Activities Performance Category) Call for Activities	Unchanged
227506	?414.1375 (Advancing Care Information Performance Category) Significant Hardships, including for small practices and decertification of EHRs	Unchanged
227505	?414.1330 and §414.1335 Quality Performance Category) Registration and Enrollment for CMS Web Interface	Unchanged
221786	$414.1430 (Partial Qualifying APM Participant (QP) election)	Unchanged
221785	?414.1360 (Improvement Activities)	Unchanged
221784	?414.1375 (Advancing Care Information Performance Category)	Unchanged
221782	?414.1400 QCDR and qualified registry self nomination	Unchanged
221781	?414.1330 and §414.1335 CMS Web Interface Submission Mechanism Instruction	Unchanged
221780	?414.1330 and §414.1335 EHR Submission Mechanism	Unchanged
221779	?414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism	Unchanged
221777	?414.1330 and §414.1335 Claims Submission Mechanism	Unchanged

ICR Details

OMB Control No: 0938-1314	ICR Reference No: 201807-0938-013
Status: Historical Inactive	Previous ICR Reference No: 201711-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Quality Payment Program/Merit-Based Incentive Payment System (MIPS) (CMS-10621)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 08/03/2018
	Date Received in OIRA: 07/31/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	03/31/2020	03/31/2020
Responses	1,161,681	0	1,161,681
Time Burden (Hours)	7,559,375	0	7,559,375
Cost Burden (Dollars)	0	0	0

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Abstract: 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 a Merit-based Incentive Payment System (MIPS) for eligible clinicians. Beginning in CY 2017, eligible clinicians are required to collect and submit data on four performance categories to CMS (quality, cost, advancing care information and improvement activities). This program replaces and consolidates portions of the PQRS, Value-based Modifier, and the Medicare EHR Incentive Program. The Act also establishes a second track, Advanced Alternative Payment Models (APMs) for clinicians to participate in instead of MIPS.

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Authorizing Statute(s): US Code: 42 USC 1395w-4 Name of Law: Medicare Access and CHIP Reauthorization Act of 2014
  

Citations for New Statutory Requirements: US Code: 42 USC 1395w-4 Name of Law: Medicare Access and CHIP Reauthorization Act of 2014

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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: 16

IC Title	Form No.	Form Name
§414.1330 and §414.1335 CMS Web Interface Submission Mechanism
§414.1400 QCDR and qualified registry self nomination
§414.1375 (Advancing Care Information Performance Category)
§414.1360 (Improvement Activities)
$414.1430 (Partial Qualifying APM Participant (QP) election)
§414.1375 (Advancing Care Information Performance Category) Significant Hardships, including for small practices and decertification of EHRs
§414.1395 (Physician Compare) Opt Out for Voluntary Participants
414.1330 (Quality Performance Category) Call for Measures	CMS-10621	Data Template for Candidate Measures
414.1445 Other Payer Advanced APM Determininations: Medicaid Specific Clinician Initiated Process
§414.1330 and §414.1335 Quality Performance Category) Registration and Enrollment for CMS Web Interface
§414.1360 (Improvement Activities Performance Category) Call for Activities
§414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process	CMS-10621, CMS-10621	Clinician Initiated Submission Form ,   Payer Initiated Submission Form
§414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism
§414.1330 and §414.1335 Claims Submission Mechanism
§414.1330 and §414.1335 EHR Submission Mechanism
414.1375 Advancing Care Information Performance Category - Call for Measures	CMS-10621	ACI Call for Measures Submission Form

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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:

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Annual Cost to Federal Government: $0

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]? No

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: 07/31/2018

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