CMS-10621 Appendix G1 (See Table 15): Measures under Consideration

Centers for Medicare & Medicaid Services

Measures under Consideration 2021

Data Template for Candidate Measures

Instructions:
1. Before accessing the CMS MERIT (Measures Under Consideration Entry/Review and Information Tool) online system, you are invited to complete
the measure template below by entering your candidate measure information in the column titled “Add Your Content Here.”
2. All rows that have an asterisk symbol * in the Field Label require a response.
3. For each row, the “Guidance” column provides details on how to complete the template and what kinds of data to include.
4. For check boxes, note whether the field is “select one” or “select all that apply.” You can click on the box to place or remove the “X.”
5. Row numbers are for convenience only and do not appear on the MERIT user interface.
6. Send any questions to [email protected].

PROPERTIES
Subsection
Measure
Information

Row
001

*Measure Title

Field Label

Measure
Information

002

*Measure description

2021 CMS MUC LIST DATA TEMPLATE

Guidance
Provide the measure title only (255 characters or
less). Put any program-specific identification (ID)
number under Characteristics, not in the title.
Note: Do not enter the CMIT ID, consensus-based
entity (endorsement) ID, former Jira MUC ID
number, or any other ID numbers here (see other
fields below). The CMS program name should not
ordinarily be part of the measure title, because
each measure record already has a required field
that specifies the CMS program. An exception
would be if there are several measures with
otherwise identical titles that apply to different
programs. In this case, including or imbedding a
program name in the title (to prevent there being
any otherwise duplicate titles) is helpful.
Provide a brief description of the measure (700
characters or less).

1

[ADD YOUR CONTENT HERE]

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Subsection
Measure
Information

Row
003

Field Label

*Numerator

Measure
Information

004

*Numerator Exclusions

Measure
Information

005

*Denominator

Measure
Information

006

*Denominator Exclusions

2021 CMS MUC LIST DATA TEMPLATE

Guidance
The upper portion of a fraction used to calculate a
rate, proportion, or ratio. An action to be counted
as meeting a measure's requirements. For all
fields, especially Numerator and Denominator, use
plain text whenever possible. If needed, convert
any special symbols, math expressions, or
equations to plain text (keyboard alphanumeric,
such as + - * /). This will help reduce errors and
speed up data conversion, team evaluation, and
MUC report formatting.

[ADD YOUR CONTENT HERE]

For all free-text fields: Be sure to spell out all
abbreviations and define special terms at their first
occurrence. This will save time and revision/editing
cycles during clearance.
For additional information on
exclusions/exceptions, see:
https://www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/MMS/Downloads/Blueprint.pdf. If
not applicable, enter ‘N/A.’
The lower part of a fraction used to calculate a
rate, proportion, or ratio. The denominator is
associated with a given population that may be
counted as eligible to meet a measure’s inclusion
requirements.
For additional information on
exclusions/exceptions, see:
https://www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/MMS/Downloads/Blueprint.pdf. If
not applicable, enter ‘N/A.’

2

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Subsection
Measure
Information

Row
007

Field Label

Measure
Information

008

*Briefly describe the peer
reviewed evidence justifying
this measure

Measure
Information

009

Evidence that the measure
can be operationalized

*Denominator Exceptions

Guidance
For additional information on
exclusions/exceptions, see:
https://www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/MMS/Downloads/Blueprint.pdf. If
not applicable, enter ‘N/A.’
Add description of evidence. If you have lengthy
text, add the evidence as an attachment, named to
clearly indicate the related form field. You may
attach the completed CMS consensus-based entity
“Evidence Attachment” if applicable.
Provide evidence that the data source used by the
measure is readily available to CMS. Summarize
how CMS would operationalize the measure. For
electronic clinical quality measures (eCQMs),
attach feasibility scorecard or other quantitative
evidence indicating measure can be reported by
the intended reporting entities.

[ADD YOUR CONTENT HERE]

If you have lengthy text, add the evidence as an
attachment, named to clearly indicate the related
form field.

Subsection
Burden

Row
010

Burden

011

Burden

012

Burden

013

Field Label

Guidance

*Burden for Patient: Does
the measure require survey
data from the patient?

Select one

*If yes, what is the
frequency of requests for
survey data per year?

Enter the number of requests per patient per year.

*If yes, what is the
estimated time to complete
the survey?

Enter time in minutes. If unknown, enter 0.

*If yes, are the survey data

Select all that apply

[ADD YOUR CONTENT HERE]

☐ Prior to visit
☐ During visit
☐ After visit

to be collected during or
outside of a visit?

2021 CMS MUC LIST DATA TEMPLATE

☐ Yes
☐ No

3

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Subsection
Burden

Burden

Burden

Burden

Row
014

015

016

017

Field Label

Guidance

*Burden for Provider: Was a

Select one

*If yes, how many sites

Enter the number of sites that were evaluated in
the provider workflow analysis.

*Did the provider workflow

Select one

☐ Yes
☐ No

*If yes, how would you

Select one

*Does the measure require

Select one

☐
☐
☐
☐
☐
☐
☐

*If yes, what is the
estimated time per record to
abstract data?

Enter time in minutes. If unknown, enter 0.

provider workflow analysis
conducted?

were evaluated in the
provider workflow analysis?
have to be modified to
accommodate the new
measure?
describe the degree of
effort?

Burden

018

Burden

019

Burden

020

manual abstraction?

*How many data elements

will be collected for the
measure?

2021 CMS MUC LIST DATA TEMPLATE

☐ Yes
☐ No

[ADD YOUR CONTENT HERE]

1 (little to no effort)
2
3
4
5 (substantial effort)
Yes
No

Enter number of elements. If a data element has
to be abstracted more than once per record (e.g.,
medication dose is abstracted once for each of the
patient’s medications), estimate the average
number of times it would be abstracted per
eligible case and include that in the total number
of data elements.

4

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Subsection
State of
Devel.

Row
021

State of
Devel.

022

Field Label

*State of Development

State of Development
Details

Guidance
Select all that apply. Before selecting
“Conceptualization” or “Specification,” or “Field
Testing,” check program requirements.
If “Conceptualization,” or “Specification,” describe
when testing is planned (i.e., specific dates), what
type of testing is planned (e.g., alpha, beta) as well
as the types of facilities in which the measure will
be tested.

[ADD YOUR CONTENT HERE]
☐ Conceptualization
☐ Specification
☐ Field Testing
☐ Fully Developed

If “Field Testing” or “Fully Developed,” describe
what testing (e.g., alpha, beta) has taken place in
addition to the results of that testing.

State of
Devel.

023

*At what level(s) of analysis

Summarize results from validity testing and
reliability testing. For additional information, see:
https://www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/MMS/Downloads/Blueprint.pdf
Select all that apply

was the measure tested?

2021 CMS MUC LIST DATA TEMPLATE

5

☐
☐
☐
☐
☐
☐
☐
☐

Clinician
Group
Facility
Health plan
Medicaid program (e.g., Health Home or 1115)
State
Not yet tested
Other (enter here):

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Subsection
State of
Devel.

Row
024

Field Label

Subsection
Reliability
Testing
Reliability
Testing

Row
025

*Type of Reliability Testing

Select all that apply

026

*Reliability Testing: Type of

Select all that apply

Reliability
Testing

027

*Reliability testing sample

For the reliability testing provided, indicate the
number of measured entities sampled.

Reliability
Testing

028

*Reliability testing statistical

For the reliability testing provided, indicate the
statistical result(s) of the testing analysis. If data
element reliability was conducted, provide the
scores for the critical data elements tested. If
signal-to-noise was conducted for measure score
reliability, give the range of reliability scores for
measured entities in addition to the mean.

*In which setting was this

Select all that apply.

Guidance

measure tested?

Field Label

result

2021 CMS MUC LIST DATA TEMPLATE

[ADD YOUR CONTENT HERE]
Ambulatory surgery center
Ambulatory/office-based care
Behavioral health clinic or inpatient psychiatric facility
Community hospital
Dialysis facility
Emergency department
Federally qualified health center (FQHC)
Hospital outpatient department (HOD)
Home health
Hospice
Hospital inpatient acute care facility
Inpatient rehabilitation facility
Long-term care hospital
Nursing home
PPS-exempt cancer hospital
Skilled nursing facility
Veterans Health Administration facility
Other (enter here):

☐
☐
☐
☐
☐
☐
☐
☐
☐

[ADD YOUR CONTENT HERE]
Measure Score Reliability
Data Element Reliability
Signal to Noise
Random Split Half Correlation
IRR (Inter-rater reliability)
ICC (Intraclass correlation coefficient)
Test-Retest
Internal Consistency
Other (enter here):

Guidance

Testing Analysis

size

☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

6

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Subsection
Reliability
Testing

Row
029

Reliability
Testing

030

Reliability
Testing

031

Subsection
Validity
Testing
Validity
Testing

Row
032

Field Label

*Reliability testing

interpretation of results
Reliability Testing: Was a
minimum number of
denominator cases per
measured entity established
to achieve sufficient
measure score reliability?
If yes, specify the number of
cases and the percentage of
providers

Field Label

Guidance
For the reliability testing provided, briefly describe
the interpretation of results.
☐ Yes
☐ No

Select one

Enter the minimum number of denominator cases
required for each measured entity to report on
this measure.
Also, specify the percentage of providers in the
test sample that met the minimum denominator
requirement.
Guidance

* Type of Validity Testing

Select all that apply

033

*Validity Testing: Type of
Validity Testing Analysis

Select all that apply

Validity
Testing
Validity
Testing

034

*Validity testing sample size

035

*Validity testing statistical
result

Validity
Testing

036

*Validity testing

For the validity testing provided, indicate the
number of measured entities sampled.
For the validity testing provided, indicate the
statistical result(s) of the testing analysis. If data
element validity was conducted, provide the
scores for the critical data elements tested. If face
validity was conducted, list the total number of
voting members in addition to the percentage that
voted in favor of the measure’s face validity.
For the validity testing provided, indicate the
interpretation of results.

interpretation of results

2021 CMS MUC LIST DATA TEMPLATE

[ADD YOUR CONTENT HERE]

☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

7

[ADD YOUR CONTENT HERE]
Measure Score Validity
Data Element Validity
Correlation
Face Validity
Construct Validity
Gold Standard Comparison
Internal Consistency
Predictive Validity
Structural Validity
Other (enter here):

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Subsection
Measure
Performance

Row
037

Measure
Performance

Field Label

Guidance

*Measure performance -

Select one

038

*Measure performance
score interpretation

Select one

Measure
Performance

039

*Provide mean performance

Provide the mean performance rate and standard
deviation for the measure’s submission method(s).
If the measure has more than one submission
method, provide all that are available, indicating
which results correspond to which method.

Measure
Performance

040

*Benchmark, if applicable

Provide the benchmark for the measure’s
performance rate. If not applicable, type “not
applicable.”

Subsection
Impact

Row
041

Impact

type of score

042

rate and standard deviation
for each submission method
a measure has or is
anticipated to have

Field Label

* Meaningful to Patients.

Select one

*If yes, choose all methods

Select all that apply

Was input collected from
patient and/or caregiver?

Guidance

☐ Proportion
☐ Ratio
☐ Mean
☐ Median
☐ Continuous Variable
☐ Other (enter here):
☐ Higher score is better
☐ Lower score is better
☐ Score falling within a defined interval
☐ Passing Score
☐ Other (enter here):

☐ Yes
☐ No

[ADD YOUR CONTENT HERE]

☐ Standard Technical Expert Panel (TEP) inclusive of
patient/caregiver representatives
☐ TEP consisting of ONLY patients or family representatives
☐ Focus groups
☐ Working groups
☐ One-on-one interviews
☐ Surveys
☐ Virtual communities
☐ Other (enter here):

of obtaining
patient/caregiver
information.

2021 CMS MUC LIST DATA TEMPLATE

[ADD YOUR CONTENT HERE]

8

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Subsection
Impact

Row
043

Field Label
How many times and at
what phase(s) of measure
development was the
patient/caregiver engaged?

Impact

044

*Total number of patients

Impact

045

Impact

046

Impact

047

Impact

048

Impact

049

Impact

050

and/or caregivers consulted
Specify the ratio of
patients/caregivers to
policy/clinician experts
engaged in TEP or working
groups

*Total number of
patients/caregivers who
agreed that the measure
information helps inform
care and make decisions

Guidance
Specify the number of times the patient/caregiver
representatives were engaged and at what phases
of measure development. For example,
patient/caregivers were engaged a total of 2 times.
Once during conceptualization and once at the
conclusion of specification.
Indicate number

[ADD YOUR CONTENT HERE]

Number of patients/caregivers : number of
policy/clinician experts. For example, 1:2

Indicate number

*Meaningful to Clinicians.

Select one

☐ Yes
☐ No

*If yes, choose all methods
that obtained clinician
and/or provider input

Select all that apply

*Total number of

Indicate number

☐ Standard TEP
☐ TEP consisting of ONLY clinicians
☐ Focus groups
☐ Working groups
☐ One-on-one interviews
☐ Surveys
☐ Virtual communities
☐ Other (enter here)

*Total number of

Indicate number

Were clinicians and/or
providers consulted?

clinicians/providers
consulted
clinicians/providers who
agreed that the measure
was actionable to improve
quality of care

2021 CMS MUC LIST DATA TEMPLATE

9

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Subsection
Impact

Row
051

Field Label

*Estimated impact of the

Guidance
Enter numerical value or “unable to determine.”

[ADD YOUR CONTENT HERE]

measure: Estimate of annual
denominator size
Impact

052

*Estimate of annual

Enter numerical value or “not applicable.” State
the expected improvement in absolute terms in
the units expressed by the measure, for example,
percentage points or patients per 1000. Using the
estimated annual denominator size and median
measure scores from your test data, estimate the
number of additional numerator events or
outcomes that would be achieved during each
performance period if measured entities below the
median score achieved at least the median
measure score. For inverse measures, estimate the
number of additional numerator events or
outcomes avoided if measured entities above the
median score achieved the median measure score.

Field Label

Guidance
Numeric dollar value, “not applicable,” or “unable
to determine.” Enter the estimated average net
cost avoided per event as a numeric dollar value. If
there is no anticipated impact, state “none.” If you
are unable to estimate costs avoided, state
“unable to determine.” If costs avoided are not an
appropriate metric for your measure focus (e.g.,
mortality), state “not applicable.”
Using the estimate for improvement and the
estimated average cost savings per event, provide
the costs that would be avoided by
Medicare/provider annually as a numeric dollar
value. If there is no anticipated impact, state
“none.” If you are unable to estimate costs
avoided, state “unable to determine.” If costs
avoided are not an appropriate metric for your
measure focus (e.g., mortality), state “not
applicable.”

improvement in measure
score

Subsection
Cost Factors

Row
053

*Estimated Cost Avoided by

the Measure: Estimate of
average cost savings per
event

Cost Factors

054

*Cost avoided annually by
Medicare/Provider

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10

[ADD YOUR CONTENT HERE]

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Subsection
Cost Factors

Row
055

*Source of estimate

Field Label

Cost Factors

056

*Year of cost literature cited

Subsection
Background
Information

Row
057

Background
Information

058

Field Label

Guidance
Briefly describe the assumptions for your cost
estimates and cite the sources of cost information.
If you did not identify sources of cost information,
state “none.” If costs avoided are not an
appropriate metric for your measure focus (e.g.,
mortality), state “not applicable.”
Provide the year of the cost estimate (e.g., 2016
dollars). If adjusted for inflation, provide the year
the estimate was adjusted to (e.g., 2020 dollars
after adjusting for inflation). If you did not identify
sources of cost information, state “none.” If costs
avoided are not an appropriate metric for your
measure focus (e.g., mortality), state “not
applicable.”
Guidance

*What is the history or
background for including
this measure on the current
year MUC list?

Select one

If currently used: Range of
year(s) this measure has
been used by CMS
Program(s).

For example: Hospice Quality Reporting (20122018)

2021 CMS MUC LIST DATA TEMPLATE

11

[ADD YOUR CONTENT HERE]

[ADD YOUR CONTENT HERE]
☐ New measure never reviewed by Measure Applications
Partnership (MAP) Workgroup or used in a CMS program
☐ Measure previously submitted to MAP, refined and
resubmitted per MAP recommendation
☐ Measure currently used in a CMS program being
submitted as-is for a new or different program
☐ Measure currently used in a CMS program, but the
measure is undergoing substantial change

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Subsection
Background
Information

Row
059

Subsection
Data
Sources

Row
060

Field Label
If currently used: What
other federal programs are
currently using this
measure?

Field Label

*What data sources are

used for the measure?

2021 CMS MUC LIST DATA TEMPLATE

Guidance
Select all that apply. These should be current use
programs only, not programs for the upcoming
year’s submittal.

Select all that apply.

Guidance

Use the next field to specify or elaborate on the
type of data source, if needed to define your
measure.

12

[ADD YOUR CONTENT HERE]
☐ Ambulatory Surgical Center Quality Reporting Program
☐ End-Stage Renal Disease Quality Incentive Program
☐ Home Health Quality Reporting Program
☐ Hospice Quality Reporting Program
☐ Hospital-Acquired Condition Reduction Program
☐ Hospital Inpatient Quality Reporting Program
☐ Hospital Outpatient Quality Reporting Program
☐ Hospital Readmissions Reduction Program
☐ Hospital Value-Based Purchasing Program
☐ Inpatient Psychiatric Facility Quality Reporting Program
☐ Inpatient Rehabilitation Facility Quality Reporting
Program
☐ Long-Term Care Hospital Quality Reporting Program
☐ Medicare and Medicaid Promoting Interoperability
Program for Eligible Hospitals and Critical Access Hospitals
(CAHs)
☐ Medicare Shared Savings Program
☐ Merit-based Incentive Payment System
☐ Part C and D Star Ratings [Medicare]
☐ Prospective Payment System-Exempt Cancer Hospital
Quality Reporting Program
☐ Quality Health Plan Quality Rating System
☐ Skilled Nursing Facility Quality Reporting Program
☐ Skilled Nursing Facility Value-Based Purchasing Program
☐ Other (enter here):
[ADD YOUR CONTENT HERE]
☐ Administrative Data (non-claims)
☐ Claims Data
☐ Electronic Clinical Data (non-EHR)
☐ Electronic Health Record
☐ Paper Medical Records
☐ Standardized Patient Assessments
☐ Patient Reported Data and Surveys
☐ Registries
☐ Hybrid
☐ Other (enter here):

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Subsection
Data
Sources
Data
Sources

Row
061

Data
Sources

063

Data
Sources

064

062

Field Label
If applicable, specify the
data source(s)
If EHR or Claims or ChartAbstracted Data, description
of parts related to these
sources

Guidance
Use this field to specify or elaborate on the type of
data source, if needed, to define your measure.
Describe the parts or elements of the measure
that are relevant to these data sources

[ADD YOUR CONTENT HERE]

*How is the measure

This is the anticipated data submission method.
Select all that apply. Use the 'Comments' field to
specify or elaborate on the type of reporting data,
if needed to define your measure.

*Feasibility of Data

To what extent are the specified data elements
available in electronically defined fields? Select all
that apply. For a PRO-PM, select the data
collection format(s).

eCQM
Clinical Quality Measure (CQM) Registry
Claims
Web interface
Other (enter here):
ALL data elements are in defined fields in administrative
claims
☐ ALL data elements are in defined fields in electronic
health records (EHRs)
☐ ALL data elements are in defined fields in electronic
clinical data (e.g., clinical registry, nursing home minimum
data set, or MDS, home health Outcome and Assessment
Information Set, or OASIS)
☐ ALL data elements are in defined fields in a combination
of electronic sources
☐ Some data elements are in defined fields in electronic
sources
☐ No data elements are in defined fields in electronic
sources
☐ Patient/family-reported information: electronic
☐ Patient/family-reported information: paper

Field Label

expected to be reported to
the program?

Elements

☐
☐
☐
☐
☐
☐

STEWARD
Subsection
Steward
Information

Row
065

*Measure steward

Guidance
Enter the current Measure Steward. Select all that
apply.

Steward
Information

066

*Measure Steward Contact

Last name, First name; Affiliation (if different);
Telephone number; Email address.

Information

2021 CMS MUC LIST DATA TEMPLATE

13

[ADD YOUR CONTENT HERE]
See Appendix A.065-067 for list choices. Copy/paste or
enter your choices here:

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Subsection
Long-Term
Steward
Information

Row
067

Field Label
Long-Term Measure Steward
(if different)

Long-Term
Steward
Information
Submitter
Information
Submitter
Information

068

Long-Term Measure Steward
Contact Information

069

Is primary submitter the
same as steward?

070

*Primary Submitter Contact

Submitter
Information

071

Information

Secondary Submitter
Contact Information

2021 CMS MUC LIST DATA TEMPLATE

Guidance
Entity or entities that will be the permanent
measure steward(s), responsible for maintaining
the measure and conducting endorsement
maintenance review. Select all that apply.
If different from Steward above: Last name, First
name; Affiliation; Telephone number; Email
address.
Select “Yes” or “No.”
If different from Steward above: Last name, First
name; Affiliation; Telephone number; Email
address. NOTE: The primary and secondary
submitters entered here do not automatically have
read/write/change access to modify this measure
in MERIT. To request such access for others, when
logged into the MERIT interface, navigate to
“About” and “Contact Us,” and indicate the name
and e-mail address of the person(s) to be added.
If different from name(s) above: Last name, First
name; Affiliation; Telephone number; Email
address.

14

[ADD YOUR CONTENT HERE]
See Appendix A.065-067 for list choices. Copy/paste or
enter your choices here:

☐ Yes
☐ No

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CHARACTERISTICS
Subsection
General
Characteristics

Row
072

Field Label

*Measure Type

General
Characteristics

073

*Is the measure a

Select one

General
Characteristics

074

*Is this measure in the

Select Yes or No. Current measures can be found
at https://cmit.cms.gov/CMIT_public/ListMeasures

General
Characteristics

075

*If yes, enter the CMIT ID

If the measure is currently in CMIT, enter the 4digit CMIT ID. Current measures and CMIT IDs can
be found at
https://cmit.cms.gov/CMIT_public/ListMeasures

General
Characteristics

076

Alternate Measure ID

DO NOT enter consensus-based entity
(endorsement) ID, CMIT ID, or previous year MUC
ID in this field. This is an alphanumeric identifier
(if applicable), such as a recognized program ID
number for this measure (20 characters or less).
Examples: 199 GPRO HF-5; ACO 28; CTM-3; PQI
#08.

composite or component
of a composite?
CMS Measures Inventory
Tool (CMIT)?

2021 CMS MUC LIST DATA TEMPLATE

Guidance
Select only one type of measure. For definitions,
visit this web site:
https://www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/QualityMeasures/Pre-RuleMaking.html .

15

[ADD YOUR CONTENT HERE]
☐ Access
☐ Communication and Care Coordination
☐ Composite
☐ Cost/Resource
☐ Cost/Resource Use
☐ Efficiency
☐ Intermediate Outcome
☐ Not Specified
☐ Outcome
☐ Patient Engagement/Experience
☐ Patient Perspective
☐ Patient Reported Outcome
☐ Process
☐ Structure
☐ Other (enter here):
☐ Yes
☐ No
☐ Yes
☐ No

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Subsection
General
Characteristics

Row
077

Field Label
Outline the clinical
guideline(s) supporting this
measure. Also see note at
Rows 082 and 083 below.

General
Characteristics

078

*What is the target
population of the measure?

General
Characteristics

079

General
Characteristics

080

*Select ALL areas of
specialty the measure is
aimed to, or which
specialties are most likely
to report this measure

General
Characteristics

*Evidence of performance

gap

081

*Unintended
consequences

2021 CMS MUC LIST DATA TEMPLATE

Guidance
Provide a detailed description of which guideline
supports the measure and how the measure will
enhance compliance with the clinical guidelines.
Indicate whether the guideline is evidence-based
or consensus-based.
What populations are included in this measure?
e.g., Medicare Fee for Service, Medicare
Advantage, Medicaid, Children’s Health Insurance
Program (CHIP), All Payer, etc.
Select all areas of specialty that apply.

[ADD YOUR CONTENT HERE]

See Appendix A.079 for list choices. Copy/paste or enter your
choice(s) here:

Evidence of a performance gap among the units of
analysis in which the measure will be
implemented. Provide analytic evidence that the
units of analysis have room for improvement and,
therefore, that the implementation of the measure
would be meaningful.
If you have lengthy text add the evidence as an
attachment, named to clearly indicate the related
form field.
Summary of potential unintended consequences if
the measure is implemented. Information can be
taken from the CMS consensus-based entity
Consensus Development Process (CDP)
manuscripts or documents. If referencing CDP
documents, you must submit the document or a
link to the document, and the page being
referenced.

16

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Subsection
Evidence

Row
082

Field Label

*Type of evidence to

Select all that apply

If you select Clinical
Guidelines and/or USPSTF
Guidelines in Row 082
above, then Row 077
(Outline the Clinical
Guidelines) becomes a
required field.

n/a

Guidance

support the measure

Evidence

083

Evidence

084

Evidence

085

Evidence

086

*Were the guidelines

Select one

*If yes, who graded the

Specify the agency or organization(s) that graded
the guidelines.

*If yes, what was the

Specify the grade that was assigned to the
guidelines.

Field Label

Guidance
Select as many as apply.

graded?

guidelines?
grade?

Subsection
Risk
Adjustment

Row
087

Risk
Adjustment

088

*Is the measure risk
adjusted, stratified, or
both?
*Are social determinants

of health built into the risk
adjustment model?

2021 CMS MUC LIST DATA TEMPLATE

[ADD YOUR CONTENT HERE]
☐ Clinical Guidelines
☐ USPSTF (U.S. Preventive Services Task Force) Guidelines
☐ Systematic Review
☐ Empirical data
☐ Other (enter here):
This is not a data entry field.

☐ Yes
☐ No

[ADD YOUR CONTENT HERE]
☐ Risk adjusted
☐ Stratified
☐ None

Select one. If it was determined that risk
adjustment for social determinants of health was
not appropriate for the risk model used, select
“not applicable.” If risk adjustments for social
determinants of health were appropriate but are
not currently built in, select “no.”

17

☐ Yes
☐ No
☐ Not Applicable

3/26/2021

Subsection
Healthcare
Domain

Row
089

Field Label

*What one healthcare

domain applies to this
measure?

Subsection
Endorsement
Characteristics

Row
090

Endorsement
Characteristics

091

Endorsement
Characteristics

092

Endorsement
Characteristics

093

Endorsement
Characteristics

094

Field Label

*What is the

endorsement status of the
measure?

*CBE ID (CMS consensus-

based entity, or
endorsement ID)

If endorsed: Is the
measure being submitted
exactly as endorsed by
the CMS CBE?
If not exactly as endorsed,
specify the locations of
the differences

If not exactly as endorsed,
describe the nature of the
differences

2021 CMS MUC LIST DATA TEMPLATE

Guidance
Select the ONE most applicable healthcare
domain. For more information, see:
https://www.cms.gov/meaningful-measures-20moving-measure-reduction-modernization

Guidance
Select only one. For information on consensusbased entity (CMS contractor) endorsement,
measure ID, and other information, refer to:
http://www.qualityforum.org/QPS/
Four- or five-character identifier with leading zeros
and following letter if needed. Add a letter after
the ID (e.g., 0064e) and place zeros ahead of ID if
necessary (e.g., 0064). If no CBE ID number is
known, enter numerals 9999.
Select 'Yes' or 'No'. Note that 'Yes' should only be
selected if the submission is an EXACT match to
the CBE-endorsed measure.
Indicate which specification fields are different.
Select all that apply.

Briefly describe the differences

18

[ADD YOUR CONTENT HERE]
☐ Person-Centered Care
☐ Equity
☐ Safety
☐ Affordability and Efficiency
☐ Chronic Conditions
☐ Wellness and Prevention
☐ Seamless Care Coordination
☐ Behavioral Health

☐
☐
☐
☐
☐

[ADD YOUR CONTENT HERE]
Endorsed
Endorsement Removed
Submitted
Failed endorsement
Never submitted

☐ Yes
☐ No
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

Measure title
Description
Numerator
Denominator
Exclusions
Target Population
Setting (for testing)
Level of analysis
Data source
eCQM status
Other (enter here and see next field):

3/26/2021

Subsection
Endorsement
Characteristics

Row
095

Field Label
If endorsed: Year of most
recent CDP endorsement

Select one

Guidance

Endorsement
Characteristics

096

Year of next anticipated
CDP endorsement review

Select one. If you are submitting for initial
endorsement, select the anticipated year.

☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

None
2017
2018
2019
2020
2021
None
2021
2022
2023
2024
2025

[ADD YOUR CONTENT HERE]

GROUPS
Subsection
N/A

Row
097

Field Label

N/A

098

*If eCQM: Measure
Authoring Tool (MAT)
Number

N/A

099

* If eCQM, does the

*Is this measure an
electronic clinical quality
measure (eCQM)?

measure have a Health
Quality Measures Format
(HQMF) specification in
alignment with the latest
HQMF and eCQM
standards, and does the
measure align with
Clinical Quality Language
(CQL) and Quality Data
Model (QDM)?

2021 CMS MUC LIST DATA TEMPLATE

Guidance
Select 'Yes' or 'No'. If your answer is yes, the
Measure Authoring Tool (MAT) ID number must be
provided below. For more information on eCQMs,
see: https://www.emeasuretool.cms.gov/
You must attach Bonnie test cases for this
measure, with 100% logic coverage (test cases
should be appended), attestation that value sets
are published in Value Set Authority Center
(VSAC), and feasibility scorecard. If not an eCQM,
or if MAT number is not available, enter 0.
Select 'Yes' or 'No'. For additional information on
HQMF standards, see:
https://ecqi.healthit.gov/tool/hqmf

19

☐ Yes
☐ No

[ADD YOUR CONTENT HERE]

☐ Yes
☐ No

3/26/2021

Subsection
Burden

Burden

Row
100

101

Field Label

* If this measure is an

Select one

*If yes, how would you

Select one

eCQM, does any
electronic health record
(EHR) system tested need
to be modified?

Guidance

[ADD YOUR CONTENT HERE]

☐ 1 (little to no effort)
☐2
☐3
☐4
☐ 5 (substantial effort)

describe the degree of
effort?

2021 CMS MUC LIST DATA TEMPLATE

☐ Yes
☐ No

20

3/26/2021

PROGRAMS
Subsection
N/A

Row
102

Field Label

*Select the CMS

program(s) for which the
measure is being
submitted.

Select all that apply.

Guidance

If you are submitting for MIPS, there are two
choices of program. Choose MIPS-Quality for
measures that pertain to quality and/or efficiency.
Choose MIPS-Cost only for measures that pertain
to cost. Do not enter both MIPS-Quality and MIPSCost for the same measure.
Because you selected MIPS, you are required to
download the MIPS Peer Reviewed Journal Article
Template and attach the completed form to your
submission using the “Attachments” page.

N/A

103

MIPS Quality: Identify any
links with related Cost
measures and
Improvement Activities

2021 CMS MUC LIST DATA TEMPLATE

For MIPS Quality measures only: Where available,
provide description of linkages and a rationale that
correlates this MIPS quality measure to other
performance category measures and activities.

21

[ADD YOUR CONTENT HERE]
☐Ambulatory Surgical Center Quality Reporting Program
☐ End-Stage Renal Disease (ESRD) Quality Incentive
Program
☐ Home Health Quality Reporting Program
☐ Hospice Quality Reporting Program
☐ Hospital-Acquired Condition Reduction Program
☐ Hospital Inpatient Quality Reporting Program
☐ Hospital Outpatient Quality Reporting Program
☐ Hospital Readmissions Reduction Program
☐ Hospital Value-Based Purchasing Program
☐ Inpatient Psychiatric Facility Quality Reporting
Program
☐ Inpatient Rehabilitation Facility Quality Reporting
Program
☐ Long-Term Care (LTC) Hospital Quality Reporting
Program
☐ Medicare and Medicaid Promoting Interoperability
Program for Eligible Hospitals and Critical Access
Hospitals (CAHs)
☐ Medicare Shared Savings Program
☐ Merit-based Incentive Payment System-Cost
☐ Merit-based Incentive Payment System-Quality
☐ Part C and D Star Ratings [Medicare]
☐ Prospective Payment System-Exempt Cancer Hospital
Quality Reporting Program
☐ Skilled Nursing Facility Quality Reporting Program
☐ Skilled Nursing Facility Value-Based Purchasing
Program

3/26/2021

SIMILAR MEASURES
Subsection
Similar In-Use
Measures

Row
104

Similar In-Use
Measures

105

Similar In-Use
Measures

106

Similar In-Use
Measures

107

Subsection
Previous
Measures

Row
108

Previous
Measures

109

Field Label

*Is this measure similar to
and/or competing with
measure(s) already in a
program?
If Yes: Which measure(s)
already in a program is
your measure similar to
and/or competing with?
If Yes: How will this
measure add value to the
CMS program?
If Yes: How will this
measure be distinguished
from other similar and/or
competing measures?
Field Label

*Was this measure
published on a previous
year's Measures under
Consideration list?
In what prior year(s) was
this measure published?

2021 CMS MUC LIST DATA TEMPLATE

Guidance
Select either Yes or No. Consider other measures
with similar purposes.

☐ Yes
☐ No

[ADD YOUR CONTENT HERE]

Identify the other measure(s) including title and
any other unique identifier.
Describe benefits of this measure, in comparison
to measure(s) already in a program.
Describe key differences that set this measure
apart from others.

Guidance
Select 'Yes' or 'No'. If yes, you are submitting an
existing measure for expansion into additional
CMS programs or the measure has substantially
changed since originally published.
Select all that apply. NOTE: If your measure was
published on more than one prior annual MUC
List, as you use the MERIT interface, click “Add
Another Measure” and complete the information
section for each of those years.

22

☐ Yes
☐ No

☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

[ADD YOUR CONTENT HERE]

None
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Other (enter here):

3/26/2021

Subsection
Previous
Measures
Previous
Measures

Row
110

Previous
Measures

112

Previous
Measures

113

Previous
Measures

114

Previous
Measures

115

Previous
Measures

116

111

Field Label
What were the MUC IDs for
the measure in each year?
List the CMS CBE MAP
workgroup(s) in each year

What were the programs
that MAP reviewed the
measure for in each year?
What was the MAP
recommendation in each
year?
Why was the measure not
recommended by the MAP
workgroups in those
year(s)?
MAP report page number
being referenced for each
year
If this measure is being
submitted to meet a
statutory requirement, list
the corresponding statute

2021 CMS MUC LIST DATA TEMPLATE

Guidance
List both the year and the associated MUC ID
number in each year. If unknown, enter N/A.
List both the year and the associated workgroup
name in each year. Workgroup options: Clinician;
Hospital; Post-Acute Care/Long-Term Care;
Coordinating Committee. Example: "Clinician,
2014."
List both the year and the associated program
name in each year.

[ADD YOUR CONTENT HERE]

List the year(s), the program(s), and the
associated recommendation(s) in each year.
Options: Support; Do Not Support; Conditionally
Support; Refine and Resubmit.
Briefly describe the reason(s) if known.

List both the year and the associated MAP report
page number for each year.
List title and other identifying citation
information.

23

3/26/2021

ATTACHMENTS
Subsection
N/A

Row
117

Field Label
Attachment(s)

Guidance
You are encouraged to attach the measure
information form (MIF) if available. This is a
detailed description of the measure used by the
CMS consensus-based entity (CBE) during
endorsement proceedings. If a MIF is not
available, comprehensive measure methodology
documents are encouraged.

[ADD YOUR CONTENT HERE]

If you are submitting for MIPS (either Quality or
Cost), you are required to download the MIPS
Peer Reviewed Journal Article Template and
attach the completed form to your submission
using the “Attachments” feature. See
https://www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/QualityMeasures/Pre-Rulemaking

N/A

118

MIPS Peer Reviewed
Journal Article Template

If eCQM, you must attach MAT Output/HQMF,
Bonnie test cases for this measure, with 100%
logic coverage (test cases should be appended),
attestation that value sets are published in VSAC,
and feasibility scorecard.
Select Yes or No. For those submitting measures
to MIPS program, enter “Yes.” Attach your
completed Peer Reviewed Journal Article
Template.

☐ Yes
☐ No

COMMENTS
Subsection
N/A

Row
119

Field Label
Submitter Comments

Guidance
Any notes, qualifiers, external references, or
other information not specified above.

[ADD YOUR CONTENT HERE]

Send any questions to [email protected]

2021 CMS MUC LIST DATA TEMPLATE

24

3/26/2021

Appendix: Lengthy Lists of Choices
A.065-067

Choices for Measure Steward (065) and Long-Term Measure Steward (if different) (067)

Agency for Healthcare Research & Quality
Alliance of Dedicated Cancer Centers
Ambulatory Surgical Center (ASC) Quality Collaboration
American Academy of Allergy, Asthma & Immunology (AAAAI)
American Academy of Dermatology
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Otolaryngology – Head and Neck Surgery (AAOHN)
American College of Cardiology
American College of Cardiology/American Heart Association
American College of Emergency Physicians
American College of Emergency Physicians (previous steward Partners-Brigham
& Women's)
American College of Obstetricians and Gynecologists (ACOG)
American College of Radiology
American College of Rheumatology
American College of Surgeons
American Gastroenterological Association
American Health Care Association
American Medical Association
American Nurses Association
American Psychological Association
American Society for Gastrointestinal Endoscopy
American Society for Radiation Oncology
American Society of Addiction Medicine
American Society of Anesthesiologists
American Society of Clinical Oncology
American Society of Clinical Oncology
American Urogynecologic Society
American Urological Association (AUA)
Audiology Quality Consortium/American Speech-Language-Hearing Association
(AQC/ASHA)
Bridges to Excellence
Centers for Disease Control and Prevention

2021 CMS MUC LIST DATA TEMPLATE

25

Centers for Medicare & Medicaid Services
Eugene Gastroenterology Consultants, PC Oregon Endoscopy Center, LLC
Health Resources and Services Administration (HRSA) - HIV/AIDS Bureau
Heart Rhythm Society (HRS)
Indian Health Service
Infectious Diseases Society of America (IDSA)
Intersocietal Accreditation Commission (IAC)
KCQA- Kidney Care Quality Alliance
Minnesota (MN) Community Measurement
National Committee for Quality Assurance
National Minority Quality Forum
Office of the National Coordinator for Health Information Technology/Centers
for Medicare & Medicaid Services
Oregon Urology Institute
Oregon Urology Institute in collaboration with Large Urology Group Practice
Association
Pharmacy Quality Alliance
Philip R. Lee Institute for Health Policy Studies
Primary (care) Practice Research Network (PPRNet)
RAND Corporation
Renal Physicians Association; joint copyright with American Medical
Association Seattle Cancer Care Alliance
Society of Gynecologic Oncology
Society of Interventional Radiology
The Academy of Nutrition and Dietetics
The Joint Commission
The Society for Vascular Surgery
The University of Texas MD Anderson Cancer Center
University of Minnesota Rural Health Research Center
University of North Carolina- Chapel Hill
Wisconsin Collaborative for Healthcare Quality (WCHQ)
Other (enter in Row 065 and/or Row 067)

3/26/2021

A.079 Choices for Areas of specialty (079)
Addiction medicine
Allergy/immunology
Anesthesiology
Behavioral health
Cardiac electrophysiology
Cardiac surgery
Cardiovascular disease (cardiology)
Chiropractic medicine
Colorectal surgery (proctology)
Critical care medicine (intensivists)
Dermatology
Diagnostic radiology
Electrophysiology
Emergency medicine
Endocrinology
Family practice
Gastroenterology
General practice
General surgery
Geriatric medicine
Gynecological oncology
Hand surgery
Hematology/oncology
Hospice and palliative care

Infectious disease
Internal medicine
Interventional pain management
Interventional radiology
Maxillofacial surgery
Medical oncology
Nephrology
Neurology
Neuropsychiatry
Neurosurgery
Nuclear medicine
Nursing
Nursing homes
Obstetrics/gynecology
Occupational therapy
Ophthalmology
Optometry
Oral surgery (dentists only)
Orthopedic surgery
Osteopathic manipulative medicine
Otolaryngology
Pain management
Palliative care
Pathology

Pediatric medicine
Peripheral vascular disease
Physical medicine and rehabilitation
Physical therapy
Plastic and reconstructive surgery
Podiatry
Preventive medicine
Primary care
Psychiatry
Public and/or population health
Pulmonary disease
Pulmonology
Radiation oncology
Rheumatology
Sleep medicine
Speech therapy
Sports medicine
Surgical oncology
Thoracic surgery
Urology
Vascular surgery
Other (enter in Row 079)

Send any questions to [email protected]
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average 3.5 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,
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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 QPP at [email protected]

2021 CMS MUC LIST DATA TEMPLATE

26

3/26/2021