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 CAHPS for MIPS Survey Vendor Application	Form and Instruction	Modified	Available
Form CMS-10450 CAHPS for MIPS Survey Beneficiary Participation	Form	Modified	Repair queued
CMS-10450 CAHPS for MIPS SS Part B (06-29-18).docx	Supporting Statement B	Uploaded 2018-08-22	Available
CMS-10450 CAHPS for MIPS SS Part A (07-03-18) (rev OSORA PRA).docx	Supporting Statement A	Uploaded 2018-08-22	Available
Appendix G Technical References.docx	Supplementary Document	Uploaded 2018-08-21	Available
Appendix I 2018 CAHPS for MIPS Vendor Participation Form Crosswalk_2018-07-02.docx	Supplementary Document	Uploaded 2018-08-21	Available
Appendix A CAHPS for MIPS Crosswalk 12.04.2017.docx	Supplementary Document	Uploaded 2018-08-21	Available

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
206234	CAHPS for MIPS Survey Beneficiary Participation	Form	Modified

ICR Details

OMB Control No: 0938-1222	ICR Reference No: 201807-0938-014
Status: Historical Inactive	Previous ICR Reference No: 201712-0938-014
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
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: Comment filed on proposed rule and continue	Conclusion Date: 09/27/2018
	Date Received in OIRA: 09/11/2018
Terms of Clearance: 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.

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	132,783
Time Burden (Hours)	29,950	0	29,950
Cost Burden (Dollars)	0	0	0

---

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.

---

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

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AT31	Proposed rulemaking	83 FR 35704	07/27/2018

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 35704	07/27/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
CAHPS for MIPS Survey Vendor Application	CMS-10450, CMS-10450	Appendix F: Vendor Form ,   Appendix H: Vendor Attestation
CAHPS for MIPS Survey Beneficiary Participation	CMS-10450, CMS-10450	Attachment B: Mail Survey ,   Appendix E: CATI Script
CAHPS for MIPS Group Registration

---

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: The total estimated burden associated with this revision is 14,636 hours, a reduction of 15,314 hours.

---

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

---

Common Form ICR:  No

---

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: 09/11/2018

---