(CMS-10621) Merit-based Incentive Payment System

Forms and Documents

Document Name	Status
Form CMS-10621 ?414.1360 (Improvement Activities) Form and Instruction	Modified
Form CMS-10621 ?414.1375 (Advancing Care Information Performance Category) Form and Instruction	Modified
Form CMS-10621 ?414.1400 QCDR and qualified registry self nomination Form and Instruction	Modified
Form CMS-10621 ?414.1330 and §414.1335 CMS Web Interface Submission Mechanism Form and Instruction	Modified
Form CMS-10621 ?414.1330 and §414.1335 EHR Submission Mechanism Form and Instruction	Modified
Form CMS-10621 ?414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism Form and Instruction	Modified
Form CMS-10621 ?414.1330 and §414.1335 Claims Submission Mechanism Form and Instruction	Modified
MIPS Response_to_Public_Comments 10.13.2016.doc Supplementary Document	2016-11-01
MIPS PRA Supporting Statement Part B - Passback- clean 3.31.201....doc Supporting Statement B	2017-03-31
MIPS PRA Supporting Statement Part A - Passback-clean 3.16.2017.doc Supporting Statement A	2017-03-29

IC Document Collections

IC ID	Document Title	Status
224260	414.1400 (Quality Performance Category) CAPHs for MIPS	New
221786	$414.1430 (Partial Qualifying APM Participant (QP) election)	Modified
221785	?414.1360 (Improvement Activities) Form and Instruction	Modified
221784	?414.1375 (Advancing Care Information Performance Category) Form and Instruction	Modified
221783	?414.1390 (Data Validation and Auditing)	Modified
221782	?414.1400 QCDR and qualified registry self nomination Form and Instruction	Modified
221781	?414.1330 and §414.1335 CMS Web Interface Submission Mechanism Form and Instruction	Modified
221780	?414.1330 and §414.1335 EHR Submission Mechanism Form and Instruction	Modified
221779	?414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism Form and Instruction	Modified
221777	?414.1330 and §414.1335 Claims Submission Mechanism Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1314	ICR Reference No: 201611-0938-002
Status: Historical Active	Previous ICR Reference No: 201606-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: (CMS-10621) Merit-based Incentive Payment System
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: 03/31/2017
	Date Received in OIRA: 11/01/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved
Responses	1,689,076	0	0
Time Burden (Hours)	10,947,453	0	0
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 will be required to collect and submit data on four performance categories to CMS (quality, resource use, advancing care information, and clinical practice improvement activity). This program replaces and consolidates portions of the PQRS, Value-based Modifier, and Medicare EHR Medicare Incentive Program.

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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-AS69	Final or interim final rulemaking	81 FR 77008	11/04/2016

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 10

IC Title	Form No.	Form Name
§414.1330 and §414.1335 Qualified Registry or QCDR Submission Mechanism	CMS-10621	List of Quality Performance Category Measures
§414.1360 (Improvement Activities)	CMS-10621	Improvement Activities Inventory
$414.1430 (Partial Qualifying APM Participant (QP) election)
414.1400 (Quality Performance Category) CAPHs for MIPS
§414.1330 and §414.1335 Claims Submission Mechanism	CMS-10621	List of Quality Performance Category Measures
§414.1330 and §414.1335 EHR Submission Mechanism	CMS-10621	List of Quality Performance Category Measures
§414.1330 and §414.1335 CMS Web Interface Submission Mechanism	CMS-10621	List of Quality Performance Category Measures
§414.1400 QCDR and qualified registry self nomination	CMS-10621	QCDR Self-nomination form
§414.1390 (Data Validation and Auditing)	CMS-10621, CMS-10621
§414.1375 (Advancing Care Information Performance Category)	CMS-10621	List of Advancing Care Information Performance Category

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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	1,689,076	0	0	1,689,076	0	0
Annual Time Burden (Hours)	10,947,453	0	0	10,947,453	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is a change in the burden because are changes in the number of respondents.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 11/01/2016

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