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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10621 414.1330 (Quality Performance Category) Call for Measures	Form and Instruction	Unchanged	Available
Form CMS-10621 414.1375 Advancing Care Information Performance Category - Call for Measures	Form and Instruction	Unchanged	Available
Form CMS-10621 ?414.1440 Other Payer Advanced APM Identification: Other Payer Initiated Process	Form and Instruction	Modified	Available
CMS-10621 non-substantive change justification.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-08-03	Available
CMS-10621 MIPS CY 2018 Supporting Statement Part B 11-17-17.doc	Supporting Statement B	Uploaded 2017-11-17	Available
CMS-10621 MIPS CY 2018 SS part A Final Rule 20171227 clean final.docx	Supporting Statement A	Uploaded 2018-01-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
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: 201808-0938-005
Status: Historical Active	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: Approved with change	Conclusion Date: 09/27/2018
	Date Received in OIRA: 08/03/2018
Terms of Clearance:

table that charts list comparision

	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

---

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.

---

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

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AT13	Not associated with rulemaking	82 FR 53568	11/16/2017

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 16

table that charts list of burden

IC Title	Form No.	Form Name
§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
414.1375 Advancing Care Information Performance Category - Call for Measures	CMS-10621	ACI Call for Measures Submission Form
§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
§414.1330 and §414.1335 CMS Web Interface Submission Mechanism
§414.1400 QCDR and qualified registry self nomination

---

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	1,161,681	1,161,681	0	0	0	0
Annual Time Burden (Hours)	7,559,375	7,559,375	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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 the information collections submitted for approval as a revision of OMB control number 0938-1314 is 7,559,375 hours with a total labor cost of $693,172,985, shown in Table 22. In the proposed rule, we estimated a total of 9,361,065 hours with a total cost of $856,214,758 for the information collections submitted for approval as a revision of OMB control number 0938-1314. In the final rule with comment period, we have revised our estimate to 7,559,375 hours with a total cost of $693,172,985. The final rule is a decrease in burden of 1,801,690 hours and a decrease of $163 million in the labor cost.

---

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

---

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: 08/03/2018

---