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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Appendix L 2023 MVP Registration Form	Form and Instruction	Modified	Available
Form Appendix K1 2023 Partial QP Election Form	Form and Instruction	Modified	Available
Form Appendix J1 2024 MVP Candidates: Instructions and Template	Form and Instruction	Modified	Available
Form Appendix I1 2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide	Form and Instruction	Modified	Available
Form Appendix H1 2023 MIPS Promoting Interoperability Hardship Exception Application Guide	Form and Instruction	Modified	Available
Form Appendix G1 Improvement Activities Performance Category, 2024 Call for Activities Submission Form	Form and Instruction	Modified	Available
Form Appendix F 2023 Peer Reviewed Journal Article Requirement Template	Form and Instruction	Modified	Available
Form Appendix E Measures under Consideration 2023 Data Template for Candidate Measures	Form and Instruction	Modified	Available
Form Appendix D1 2024 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option	Form and Instruction	Modified	Repair queued
Form Appendix C1 2024 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form)	Form and Instruction	Modified	Repair queued
Form Appendix B1 2024 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)	Form	Modified	Available
Form Appendix A1 2024 MIPS QCDR and Registry Self-nomination User Guide	Form and Instruction	Modified	Available
Form Appendix A1 CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified	Repair queued
CMS-10621-Supporting Statement B (CMS-1784-F version 2).docx	Supporting Statement B	Uploaded 2023-11-16	Available
CMS-10621 - Supporting Statement A (CMS-1784-F version 2).docx	Supporting Statement A	Uploaded 2023-11-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified	2023 MVP Registration Form
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified	2023 Partial QP Election Form
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified	2024 MVP Candidates: Instructions and Template
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified	2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified	2023 MIPS Promoting Interoperability Hardship Exception Application Guide
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified	Improvement Activities Performance Category, 2024 Call for Activities Submission Form
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified	2023 Peer Reviewed Journal Article Requirement Template
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified	Measures under Consideration 2023 Data Template for Candidate Measures
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified	2024 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified	2024 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form)
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form	Modified	2024 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified	2024 MIPS QCDR and Registry Self-nomination User Guide
250664	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1314	ICR Reference No: 202311-0938-006
Status: Historical Active	Previous ICR Reference No: 202301-0938-017
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Quality Payment Program (QPP)/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: Approved with change	Conclusion Date: 02/28/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/17/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2027	36 Months From Approved	01/31/2025
Responses	191,225	0	159,528
Time Burden (Hours)	728,142	0	713,860
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-AV07	Final or interim final rulemaking	88 FR 78818	11/16/2023

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 52262	08/07/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 78818	11/16/2023
Did the Agency receive public comments on this ICR? No

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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
CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Appendix A1, Appendix B1, Appendix D1, Appendix E, Appendix F, Appendix G1, Appendix H1, Appendix K1, Appendix L, Appendix C1, Appendix I1, Appendix J1	2024 MIPS QCDR and Registry Self-nomination User Guide ,   2024 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) ,   2024 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form) ,   2024 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option ,   Measures under Consideration 2023 Data Template for Candidate Measures ,   2023 Peer Reviewed Journal Article Requirement Template ,   Improvement Activities Performance Category, 2024 Call for Activities Submission Form ,   2023 MIPS Promoting Interoperability Hardship Exception Application Guide ,   2023 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide ,   2024 MVP Candidates: Instructions and Template ,   2023 Partial QP Election Form ,   2023 MVP Registration Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	191,225	159,528	1,365	0	30,332	0
Annual Time Burden (Hours)	728,142	713,860	-4,147	0	18,429	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: The changes are due to new policy proposals set forth in the CY 2024 PFS final rule and adjustments to the currently approved burden as a result of updated data sources and assumptions.

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Annual Cost to Federal Government: $182

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: 11/17/2023

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