Form CMS-10621 Promoting Interoperability Performance Category (Call fo

Promoting Interoperability Performance Category

Call for Measures Submission Form

Submission Period February 1 through June 28, 2019 for 2021 Measures

Stakeholders must use this form to propose new measures under the Promoting Interoperability (formerly Advancing Care Information) Performance Category for the Merit-based Incentive Payment System (MIPS) in 2021. The submission deadline is June 28, 2019.

Proposals must be sent to [email protected]. Stakeholders will receive email confirmations for their submission.

SECTION 1: STAKEHOLDER INFORMATION

Provide the following information for the individual, group or association proposing a new measure for the Promoting Interoperability Performance Category under MIPS. All required fields are indicated with an asterisk (*). This information will be used to contact the stakeholder(s) if necessary, and apprise them of determinations made for their proposed measure(s).

Submitter First Name*	Middle Initial	Submitter Last Name*			Credentials (MD, DO, etc.)
Name of Organization (if applicable)*
Address Line 1 (Street Name and Number – Not a Post Office Box or Practice Name)*
Address Line 2 (Suite, Room, etc.)
City/Town*			State (2 character code)*	Zip Code (5 digits)*

Email Address* (This is how we will communicate with you.)
Business Telephone Number (include Area Code)	Extension

SECTION 2: CONSIDERATIONS WHEN PROPOSING MEASURES

CMS priorities for proposals on Promoting Interoperability Performance Category measures include those that: (1) build on the advanced use of certified EHR technology (CEHRT) using 2015 Edition Standards and Certification Criteria to increase health information exchange and interoperability, (2) continue improving program efficiency, effectiveness, and flexibility, (3) measure patient outcomes and emphasize patient safety and (4) support improvement activities and quality performance categories of MIPS. Proposals submitted by June 28, 2019 will be considered for inclusion in rulemaking effective for 2021.

When preparing proposals, please consider whether the new measure:

1. Measures patient outcomes and are patient focused

2. Promotes interoperability and health information exchange

3. Emphasizes patient safety

4. Supports improvement activities and quality performance categories of MIPS

5. Builds on the advanced use of certified EHR technology (CEHRT) using 2015 Edition Standards and Certification Criteria

6. Does not duplicate existing objectives and measures;

7. Is feasible to implement; and

8. Is able to be validated by CMS.

SECTION 3 (page 3): REQUIRED INFORMATION FOR MEASURE PROPOSALS

Proposals that do not provide information for every field/section will not be evaluated for consideration. Any information/field not applicable to the measure proposal must state “N/A” or “not applicable” or the proposal will not be considered, as the application will be judged incomplete.

1. MEASURE DESCRIPTION (Provide a description of the measure to be considered and relevance to the Promoting Interoperability performance category):

Program Relevance:

2. MEASURE TYPE (Please indicate which category your measure description fits):

Patient Outcome Measure

Process Measure

Patient Safety Measure

Other (please indicate the type of measure):

3. REPORTING REQUIREMENT (Yes/No Statement or Numerator and Denominator Description):

Indicate whether the measure should include as a reporting requirement: 1) a yes/no statement and exclusion criteria (if applicable) or 2) the numerator and denominator, threshold (if applicable) and exclusion criteria (if applicable).

YES/NO STATEMENT

Exclusion Criteria:

If applicable and rational for exclusion proposal, otherwise use N/A

OR

Denominator Language:

Numerator Language:

Threshold:

(For example: at least one (clinical action or patient) or a percentage - at least 5 percent). The clinical action must be tied to the numerator proposed language. For example: Secure Messaging Measure: For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent. Include a rationale for recommendation:

At least one (ex., Patient or clinical action)

Recommended percentage (please state –for example: at least 5 percent):

Rationale:

Exclusion Criteria:

If applicable and rationale for exclusion proposal; otherwise use N/A

4. CEHRT FUNCTIONALITIES REQUIRED FOR PROPOSED MEASURE:

Describe CEHRT functionalities that are needed to attest successfully to this proposed measure, if applicable. If you do not believe certain functionalities are required (such as an application programming interface, or API) please use N/A.

Functionality type (ex. API):

N/A

Optional:

Additional Information, suggestions and/or comments related to the Call for Measures

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is XXXX-XXXX (Expiration date: XX/XX/XXXX). The time required to complete this information collection is estimated to average 0.5 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. ****CMS Disclosure**** Please do not send applications, claims, payments, medical records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents, please contact [email protected].

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