CMS-10394 Phase 1 Application Readiness Checklist

Phase 1 Application Readiness Checklist

Phase 1 Application Readiness Checklist
This checklist helps entities through the Phase 1 application by providing a brief overview of each
application component.
Table 1: Application Readiness Checklist
Element

1.1 Entity

Readiness Assessment
•

Completed QECP Letter of Commitment (template provided by QECP Team
and in both the QECP Phase 1 Toolkit and online application) signed by a
senior executive (e.g., CEO, president, vice president, etc.) demonstrating
commitment to participate fully as a Qualified Entity (QE)

•

Incorporation documentation and, if applicable, licensure for lead entity,
contractors, vendors, partners and/or subsidiaries, as applicable

•

As applicable for contractors, vendors, partners, or subsidiaries only: list
name, role(s) on QE project, and effective agreement dates

•

As applicable: attestation of cloud service provider (CSP) the applicant plans
to use for Medicare data storage

•

As applicable: attestation of CMS Quality Improvement Organization (QIO)

•

Attestation (yes or no) of whether the applicant is a CMS-approved qualified
clinical data registry (QCDR) applying for quasi-QE status

•

Description of the entity’s business model and resources to support the cost
of the data and report development, including a budget with line item(s) to
cover QECP participation and the following:

1.2 Financial
Resources

Checkbox

[Checkbox]

[Checkbox]

• Line item for purchasing the Medicare data
• Line item for producing the public reports
•

Compiled evidence according to the QECP Program Guide to demonstrate at
least 3 years of experience in the following areas, or a rationale as to why the
applicant does not plan on engaging in one of the following areas:
• Combining claims data
• Attributing patients to providers
• Establishing statistical validity requirements for quality measures

1.3 Experience

• Establishing statistical validity requirements for efficiency/resource use
measures

[Checkbox]

• Risk adjustment
• Identification of outliers
• Defining comparison groups
• Measurement & reporting verification process
• Public reporting
• Corrections process

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Phase 1 Application Readiness Checklist

Element

Readiness Assessment
•

Checkbox

Completed QECP Data Source Attestation in the online application (a sample
version of the DSA is in the QECP Phase 1 Toolkit), including the following:
• Name of applying entity, number of claims data suppliers, geographic
area the report will cover, level of analysis for public report (regional vs.
provider-identified)
• General information for data suppliers (legal name, effective dates of
agreement, URL, volume of other-payer claims data, and geographic
area of coverage
• Whether providers are individually identified
• Pharmacy claims data volume and intention to include in measures, as
applicable
• Whether all claims received are pre-adjudicated

1.4 Claims
Data

• The years of historical data received from that supplier

[Checkbox]

• Whether there are multiple claim setting types
• Whether Medicare Advantage Covered Lives are included in supplier
volume
•

Covered Lives: minimum thresholds (at least 10% of Covered Lives in the
geographic area excluding Medicare FFS data or at least 25% of Covered Lives
including Medicare FFS data) must be met for each state and/or county in
which the entity requests Medicare FFS data

•

An explicit statement for a 5% national sample, if applicable

•

Completed DSA signature box in the Element 1.4 section of the Phase 1
application

•

If applicable, an explanation of the variation of the Covered Lives numbers
from the supplier(s) tab and the Covered Lives tab

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