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

Forms and Documents

Document Name	Status
Form CMS-10621 Nomination of MVPs (SS-A Table 21) Form and Instruction	New
Form CMS-10621 Submission of Data for All-Payer QP Determinations under the All-Payer Combination Option (see SS-A Table 25) Form	Modified
Form CMS-10621 (Quality Performance Category) Call for Quality Measures (see SS-A Table 13) Form and Instruction	Modified
Form CMS-10621 Other Payer Advanced APM Identification: Clinician Initiated Process (see SS-A Table 24) Form	Modified
Form CMS-10621 (PI Performance Category) Call for Promoting Interoperability Measures (see SS-A Table 17) Form and Instruction	Modified
Form CMS-10621 Other Payer Advanced APM Identification: Payer Initiated Process (see SS-A Table 23) Form and Instruction	Modified
Form CMS-10621 (Improvement Activities Performance Category) Nomination of Improvement Activities (see SS-A Table 20) Form	Modified
Form CMS-10621 (PI Performance Category) Reweighting Applications for Promoting Interoperability and Other Performance Categories (see SS-A Table 14) Form	Modified
CMS-10621 - Supporting Statement B (CMS-1734-P version 3).docx Supporting Statement B	2020-08-21
CMS-10621 - Supporting Statement A (CMS-1734-P version 4).docx Supporting Statement A	2020-08-21

IC Document Collections

IC ID	Document Title	Status
243257	Nomination of MVPs (SS-A Table 21) Form and Instruction	New
243256	Open Authorization Credentialing and Token Request Process (SS-A Table 5)	New
233582	Submission of Data for All-Payer QP Determinations under the All-Payer Combination Option (see SS-A Table 25) Form	Modified
233581	QPP Identity Management Application Process (see SS-A Table 9)	Unchanged
229086	(Quality Performance Category) Call for Quality Measures (see SS-A Table 13) Form and Instruction	Modified
229075	Other Payer Advanced APM Identification: Clinician Initiated Process (see SS-A Table 24) Form	Modified
229074	(PI Performance Category) Call for Promoting Interoperability Measures (see SS-A Table 17) Form and Instruction	Modified
227511	(Physician Compare) Opt Out for Voluntary Participants (see SS-A Table 26)	Modified
227509	Other Payer Advanced APM Identification: Payer Initiated Process (see SS-A Table 23) Form and Instruction	Modified
227507	(Improvement Activities Performance Category) Nomination of Improvement Activities (see SS-A Table 20) Form	Modified
227506	(PI Performance Category) Reweighting Applications for Promoting Interoperability and Other Performance Categories (see SS-A Table 14) Form	Modified
227505	(Quality Performance Category) Group Registration for CMS Web Interface (see SS-A Table 14) Instruction	Removed
221786	Partial Qualifying APM Participant (QP) Election (see SS-A Table 22)	Modified
221785	(Improvement Activities Performance Category) Data Submission (see SS-A Table 19)	Modified
221784	(PI Performance Category) Data Submission (see SS-A Table 16)	Modified
221782	Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4) Instruction	Modified
221781	(Quality Performance Category) CMS Web Interface Submission Type (see SS-A Table 13)	Removed
221780	(Quality Performance Category) eCQM Collection Type (see SS-A Table 12)	Modified
221779	(Quality Performance Category) QCDR/MIPS CQM Collection Type (see SS-A Table 11)	Modified
221777	(Quality Performance Category) Claims Collection Type (see SS-A Table 10)	Modified

ICR Details

OMB Control No: 0938-1314	ICR Reference No: 202007-0938-007
Status: Historical Inactive	Previous ICR Reference No: 201911-0938-009
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Quality Payment Program/Merit-Based Incentive Payment System (MIPS) (CMS-10621)
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: 01/05/2021
	Date Received in OIRA: 08/24/2020
Terms of Clearance: Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2022	36 Months From Approved	01/31/2022
Responses	475,198	0	475,198
Time Burden (Hours)	2,937,891	0	2,937,891
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-AU10	Proposed rulemaking	85 FR 50074	08/17/2020

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 50074	08/17/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 18

IC Title	Form No.	Form Name
(PI Performance Category) Data Submission (see SS-A Table 16)
Other Payer Advanced APM Identification: Clinician Initiated Process (see SS-A Table 24)	CMS-10621	Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form)
Submission of Data for All-Payer QP Determinations under the All-Payer Combination Option (see SS-A Table 25)	CMS-10621	Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option
(PI Performance Category) Call for Promoting Interoperability Measures (see SS-A Table 17)	CMS-10621	Promoting Interoperability Performance Category: Call for Measures Submission Form
QPP Identity Management Application Process (see SS-A Table 9)
(Improvement Activities Performance Category) Nomination of Improvement Activities (see SS-A Table 20)	CMS-10621	Improvement Activities Performance Category: Call for Activities Submission Form
Other Payer Advanced APM Identification: Payer Initiated Process (see SS-A Table 23)	CMS-10621	Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)
(Quality Performance Category) QCDR/MIPS CQM Collection Type (see SS-A Table 11)
(Quality Performance Category) Claims Collection Type (see SS-A Table 10)
(Quality Performance Category) eCQM Collection Type (see SS-A Table 12)
Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4)	CMS-10621	2020 Qualified Clinical Data Registry (QCDR) Measure Submission Template
(Improvement Activities Performance Category) Data Submission (see SS-A Table 19)
Partial Qualifying APM Participant (QP) Election (see SS-A Table 22)
(PI Performance Category) Reweighting Applications for Promoting Interoperability and Other Performance Categories (see SS-A Table 14)	CMS-10621, CMS-10621	Hardship Exception Application Form ,   Extreme and Uncontrollable Circumstances Application Form
(Physician Compare) Opt Out for Voluntary Participants (see SS-A Table 26)
(Quality Performance Category) Call for Quality Measures (see SS-A Table 13)	CMS-10621, CMS-10621	Data Template for Candidate Measures ,   Measures under Consideration 2019, Data Template for Candidate Measures
(Quality Performance Category) CMS Web Interface Submission Type (see SS-A Table 13)
(Quality Performance Category) Group Registration for CMS Web Interface (see SS-A Table 14)
Open Authorization Credentialing and Token Request Process (SS-A Table 5)
Nomination of MVPs (SS-A Table 21)	CMS-10621	MVP Candidates: Instructions and Template

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The proposed changes in this 2020 collection of information request is associated with our August 17, 2020 (85 FR 50074) proposed rule (CMS-1734-P, RIN 0938-AU10). We are removing two of our currently approved ICRs [(1) quality performance category data submission by CMS Web Interface collection type and (2) group registration for the CMS Web Interface] as a result of the proposal to sunset the CMS Web Interface. Four ICRs [(1) quality performance category data submission by QCDR and MIPS CQM collection type, (2) quality performance category data submission by eCQM collection type, (3) nomination of improvement activities, and (4) reweighting applications for Promoting Interoperability and other performance categories] reflect changes in burden due to proposed policies in the CY 2021 proposed rule. In total, we estimate an increase in burden of 66,876 hours and $6,604,565 due to updated data and assumptions as well as proposed policies.

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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? No

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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: 08/24/2020

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