Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration (CMS-10673)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10673 Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration	Form and Instruction	Modified	Available
6c_CMS-10673_Revisions to MAQI Threshold Data Submission Form_4-10-2019.pdf	Supplementary Document	Uploaded 2019-06-06	Available
4_CMS-10673_Revisions to MAQI Qualifying Arrangement Form_4-10-2019.pdf	Supplementary Document	Uploaded 2019-06-06	Available
1_CMS-10673 MAQI_Supporting Statement - Part A_4-10-2019_Clean.docx	Supporting Statement A	Uploaded 2019-04-24	Available
3a_CMS 10673_Crosswalk for Supporting Statement - Part A_4-10-19.pdf	Supplementary Document	Uploaded 2019-04-24	Available
CMS-10673_Responses to MAQI Public Comments Received for CMS_4-10-2019.docx	Supplementary Document	Uploaded 2019-04-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
233053	Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1354	ICR Reference No: 201904-0938-016
Status: Historical Inactive	Previous ICR Reference No: 201809-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-10673
Title: Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration (CMS-10673)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 07/26/2019
	Date Received in OIRA: 04/29/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2021	36 Months From Approved	10/31/2021
Responses	100,000	0	100,000
Time Burden (Hours)	1,500,000	0	1,500,000
Cost Burden (Dollars)	0	0	0

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Abstract: The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration (“the Demonstration”) is designed to test whether excluding clinicians who participate to a sufficient degree in certain payment arrangements with Medicare Advantage Organizations (MAOs) from reporting quality under the Merit-based Incentive Payment System (MIPS) will increase or maintain participation in payment arrangements with MAOs similar to Advanced Alternative Payment Models (APMs) and change the manner in which clinicians deliver care..

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Authorizing Statute(s): US Code: 42 USC 1395b-1(a)(1) Name of Law: Social Security Act of 1967
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 731	01/31/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 17165	04/24/2019
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration	CMS-10673, CMS-10673	MAQI Threshold Data Submission Form ,   MAQI Qualifying Arrangement 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: $19,762

Does this IC contain surveys, censuses, or employ statistical methods? No

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.     No

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.     No

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: 04/29/2019

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