Quality Improvement Strategy Implementation Plan and Progress Report (CMS-10540)

Forms and Documents

Document Name	Status
Form CMS-10540 Quality Improvement Strategy Implementation Plan and Progress Report Form Form and Instruction	New
CMS-10540 - QIS_PRA_July 2015_Public_Comment_Tracker_10 03 2015.xlsx Supplementary Document	2015-10-07
QIS IPPR Form Revisions Crosswalk_FINAL_06042015_508.pdf Supplementary Document	2015-07-30
CMS-10540 - QIS_PRA_Supporting_Statement_Clean_FINAL_100215.docx Supporting Statement A	2015-10-07

IC Document Collections

IC ID	Document Title	Status
217708	Quality Improvement Strategy Implementation Plan and Progress Report Form Form and Instruction	New

ICR Details

OMB Control No: 0938-1286	ICR Reference No: 201507-0938-015
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Quality Improvement Strategy Implementation Plan and Progress Report (CMS-10540)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/21/2015
	Date Received in OIRA: 07/30/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2018	36 Months From Approved
Responses	575	0	0
Time Burden (Hours)	82,800	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 1311(c)(1)(E) of the Affordable Care Act requires qualified health plans (QHPs) offered through an Exchange must implement a quality improvement strategy (QIS) as described in section 1311(g)(1). Section 1311(g)(1) of the Affordable Care Act describes this strategy as a payment structure that provides increased reimbursement or other incentives to improve the health outcomes of plan enrollees, prevent hospital readmissions, improve patient safety and reduce medical errors, promote wellness and health, and reduce health and health care disparities. Section 1311(g)(2) of the Affordable Care Act requires the Secretary to develop guidelines associated with 1311 (g)(1). Section 1311(g)(3) of the Affordable Care Act specifies the guidelines under Section 1311(g)(2) shall require the periodic reporting to the applicable Exchange the activities that a qualified health plan has conducted to implement a strategy as described in section 1311(g)(1). CMS is requesting approval for information collection associated with the QIS implementation plan and reporting to the applicable Exchange.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 1311(g) Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
   PL: Pub.L. 111 - 148 1311(e)(3) Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
   PL: Pub.L. 111 - 148 1311(c)(1) Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 1311(c)(1) Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
PL: Pub.L. 111 - 148 1311(g) Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)
PL: Pub.L. 111 - 148 1311(e)(3) Name of Law: Patient Protection and Affordable Care Act (Affordable Care Act)

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 70674	11/26/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 35362	06/19/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Quality Improvement Strategy Implementation Plan and Progress Report Form	CMS-10540	QIS Consolidated Plan and Progress Report Form

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ICR Summary 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	575	0	575	0	0	0
Annual Time Burden (Hours)	82,800	0	82,800	0	0	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: This is a new information collection.

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Annual Cost to Federal Government: $202,500

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

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? Uncollected

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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: 07/30/2015

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