(CMS–10531) Transcatheter Mitral Valve Repair (TMVR) National Coverage Decision (NCD)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10531 KCCQ-10 Form	Form and Instruction	Modified	Repair queued
Form CMS-10531 TVT Registry form for TMVR	Form and Instruction	Modified	Repair queued
CMS-10531 TEER Supporting Statement - Part A 06-03-21.docx	Supporting Statement A	Uploaded 2021-09-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215705	KCCQ-10 Form	Form and Instruction	Modified
215704	TVT Registry form for TMVR	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1274	ICR Reference No: 202109-0938-014
Status: Received in OIRA	Previous ICR Reference No: 201807-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: (CMS–10531) Transcatheter Mitral Valve Repair (TMVR) National Coverage Decision (NCD)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/24/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2021
Responses	34,596	15,588
Time Burden (Hours)	16,001	5,456
Cost Burden (Dollars)	0	0

---

Abstract: Decision Memorandum CAG#-00438N entitled Transcatheter Mitral Valve Repair (TMVR) for Degenerative Mitral Regurgitation was published August 7, 2014. In this decision, CMS determined that it the evidence is sufficient to cover TMVR under Coverage with Evidence Development for Medicare beneficiaries under certain conditions only when the provider is participating in and patients are enrolled in a qualifying clinical studies meeting certain requirements. Consistent with section 1142 of the Social Security Act, the Agency for Healthcare Research and Quality (AHRQ) supports clinical research studies that the CMS determines meet specified standards and address the specified research questions.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 35300	07/02/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 53059	09/24/2021
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
KCCQ-10 Form	CMS-10531	KCCQ-10
TVT Registry form for TMVR	CMS-10531	TVT Registry

---

ICR Summary of Burden

table that charts list of burden

	Total Request	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	34,596	15,588	0	19,008	0	0
Annual Time Burden (Hours)	16,001	5,456	0	10,545	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: No

Burden Reduction Due to:

Short Statement: The increase in the annual number of TEER procedures performed is representative of the evolving field and providers growing more comfortable with performing and providing the services. The respondents increased from 3,897 to 8,649. The burden hours increased from 4,092 to 12,974 for TEER. The total burden hour increased from 5,456 to 16,001.

---

Annual Cost to Federal Government: $3,523

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? No

---

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: 09/24/2021

---