Appendix G Improvement Activities Performance Category, 2024 Call f

Improvement Activities Performance Category
CY 2024 Call for Improvement Activities Submission Form
Improvement activities recommended for inclusion or modification should be sent using the
Improvement Activities Submission Template (below) to the email:
[email protected]. Stakeholders will receive an email confirmation for their
submission. Improvement activities submitted between February 1 and July 1, 2024 will be
considered for inclusion for the CY 2026 performance period/2028 MIPS payment year.
Improvement activities submitted after July 1, 2024 will be considered for inclusion in future
years of the Quality Payment Program. During a public health emergency (PHE), nominations
will be accepted outside of the February 1 through July 1 submission period as long as the
improvement activity is relevant to the PHE. All fields of this form must be completed in order
for your submission to be considered. Stakeholders should submit a modification submission if
the improvement activity they submitted or one that refers to a program or policy they
manage requires an update.
We also refer submitters to the 2024 MIPS Improvement Activities list on the CMS Quality
Payment Program resource library, which lists the complete Inventory of current
improvement activities for the CY 2024 performance period/2026 MIPS payment year.
Submitters should ensure that proposed new activities do not duplicate existing ones.
MIPS improvement activities considered for selection must meet all 8 of the required
acceptance criteria below:
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Relevance to an existing improvement activities subcategory (or a proposed new
subcategory);
Importance of an activity toward achieving improved beneficiary health outcomes;
Feasible to implement, recognizing importance in minimizing burden, including, to
the extent possible, for small practices, practices in rural areas, or practices in areas
designated as geographic Health Professional Shortage Areas (HPSAs) by the Health
Resources and Services Administration (HRSA);
Evidence supports that an activity has a high probability of contributing to improved
beneficiary health outcomes;
Can be linked to existing and related MIPS quality, Promoting Interoperability, and
cost measures as applicable and feasible;
CMS is able to validate the activity;
Does not duplicate other improvement activities in the Inventory; and
Should drive improvements that go beyond purely common clinical practices.

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MIPS improvement activities considered for selection can also meet one or more of the
optional acceptance criteria below. Meeting one or more of the optional criteria may
increase a submission’s chances of being added to the Inventory:
• Alignment with patient-centered medical homes;
• Support for the patient’s family or personal caregiver;
• Responds to a PHE as determined by the Secretary;
• Addresses improvements in practice to reduce health care disparities;
• Focus on meaningful actions from the person and family’s point of view; and
• Representative of activities that multiple individual MIPS eligible clinicians or
groups could perform (for example, primary care, specialty care).

Proposed New Improvement Activities Recommended for Inclusion in
the Quality Payment Program: Submission Template
Activity Sponsor:

Provide entity name, URL, and individual
contact information: name, address, phone,
email—in case we need to contact submitter.

CMS NPI # or Sponsor Type:

Include NPI number, or indicate other entity type,
e.g., EHR vendor, specialty group, or other—25
words or less.

Activity Title:

Provide the activity title only—10 words or less.

Activity Description:
Provide a brief description of the proposed
activity—300 words or less. Please be as specific
as possible about what the activity entails. E.g.,
“MIPS eligible clinician must perform/
do XXXX.”

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Proposed Subcategory:

Select the ONE (1) subcategory under which
your proposed improvement activity best fits
from among the following eight options:
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Achieving Health Equity
Behavioral and Mental Health
Beneficiary Engagement
Care Coordination
Emergency Response and
Preparedness
Expanded Practice Access
Patient Safety and Practice Assessment
Population Management

Rationale and Supporting
Documentation (e.g., peer-reviewed
articles, other publications, websites)

Describe how this activity would meet the
acceptance criteria listed above. Provide
supporting documentation that indicates that
this activity has been used successfully in the
field, and that it can lead to practice quality
improvement and improvement in patient
health, experience, etc. Please provide citations
of or links to established processes, validated
tools, etc., that are referenced in the activity.

Documentation to Use as Proof of
Activity Completion:
Include data or primary sources that a MIPS
eligible clinician could use to validate
performance of the improvement activity (e.g.,
medical charts, office schedules, data reports,
quality improvement reports or submissions to
funders/payers, meeting minutes).

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Level of Effort:

Include data, primary sources or personal
experience to substantiate the level of effort
the submitter anticipates are required to
complete the proposed improvement activity
on an annual basis. (This estimate could be in
hours/days, dollars, staffing needs/FTE,
external resources/supports or any
combination thereof).

Proposed Modifications to Improvement Activities Recommended for
Inclusion in the Quality Payment Program: Submission Template
Existing IA Proposed to Modify (please
list IA subcategory/number, e.g.,
IA_AHE_1):
Modification proposed: Please check off
the type of modification you are
proposing

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Weight
Subcategory
Description

Please list the modification you propose
INCLUDING a rationale for why you
believe this modification is warranted.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 09381314 (Expiration date: 01/31/2025). The time required to complete this information collection is estimated to
average 4.4 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, Attn: PRA
Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. ****CMS Disclosure**** Please do
not send applications, claims, payments, medical records or any documents containing sensitive information to the
PRA Reports Clearance Office. Please note that any correspondence not pertaining to the 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] 

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