View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1314
ICR Reference No:
201911-0938-009
Status:
Historical Active
Previous ICR Reference No:
201812-0938-013
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CCSQ
Title:
Quality Payment Program/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:
06/04/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/25/2019
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2022
36 Months From Approved
01/31/2022
Responses
475,198
0
644,144
Time Burden (Hours)
2,937,891
0
5,109,042
Cost Burden (Dollars)
0
0
0
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.
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
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AT72
Final or interim final rulemaking
84 FR 62998
11/15/2019
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
84 FR 40482
08/14/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 62998
11/15/2019
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
18
IC Title
Form No.
Form Name
(Improvement Activities Performance Category) Data Submission (see SS-A Table 21)
(Improvement Activities Performance Category) Nomination of Improvement Activities (see SS-A Table 22)
CMS-10621
Improvement Activities Performance Category: Call for Activities Submission Form
(PI Performance Category) Call for Promoting Interoperability Measures (see SS-A Table 19)
CMS-10621
Promoting Interoperability Performance Category: Call for Measures Submission Form
(PI Performance Category) Data Submission (see SS-A Table 18)
(PI Performance Category) Reweighting Applications for Promoting Interoperability and Other Performance Categories (see SS-A Table 16)
CMS-10621, CMS-10621
Hardship Exception Application Form
,
Extreme and Uncontrollable Circumstances Application Form
(Physician Compare) Opt Out for Voluntary Participants (see SS-A Table 27)
(Quality Performance Category) CMS Web Interface Submission Type (see SS-A Table 13)
(Quality Performance Category) Call for Quality Measures (see SS-A Table 15)
CMS-10621, CMS-10621
Data Template for Candidate Measures
,
Measures under Consideration 2019, Data Template for Candidate Measures
(Quality Performance Category) Claims Collection Type (see Table SS-A 10)
(Quality Performance Category) Group Registration for CMS Web Interface (see SS-A Table 14)
(Quality Performance Category) QCDR/MIPS CQM Collection Type (see SS-A Table 11)
(Quality Performance Category) eCQM Collection Type (see SS-A Table 12)
Other Payer Advanced APM Identification: Clinician Initiated Process (see SS-A Table 25)
CMS-10621
Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form)
Other Payer Advanced APM Identification: Payer Initiated Process (see SS-A Table 24)
CMS-10621
Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form)
Partial Qualifying APM Participant (QP) Election (see SS-A Table 23)
QPP Identity Management Application Process (see SS-A Table 9)
Self-nomination: QCDR and Qualified Registry (see SS-A Tables 3 and 4)
CMS-10621
2020 Qualified Clinical Data Registry (QCDR) Measure Submission Template
Submission of Data for All-Payer QP Determinations under the All-Payer Combination Option (see SS-A Table 26)
CMS-10621
Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option
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
475,198
644,144
0
-168,946
0
0
Annual Time Burden (Hours)
2,937,891
5,109,042
0
-2,170,343
-808
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
All burden changes are adjustments except for changes to ยง414.1400 (QCDR self nomination) which are comprised of revisions (-1,488 hours) and burden adjustments (-304 hours); and changes to the Call for Quality Measures which are comprised of revisions (+28 hours) and burden adjustments (-504 hours).
Annual Cost to Federal Government:
$0
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
Agency Contact:
Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov
Common Form ICR:
No
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:
11/25/2019
An official website of the United States government
The .gov means it's official.
The site is secure.
