Quality Payment Program (QPP)/Merit-Based Incentive Payment System (MIPS) (CMS-10621)

Forms and Documents

Document Name	Status
Form Appendix A CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction	New
Form Appendix A CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction	Removed
CMS-10621 - Supporting Statement A (CMS-1784-P version 5).docx Supporting Statement A	2023-08-24
CMS-10621-Supporting Statement B (CMS-1784-P version 2).docx Supporting Statement B	2023-07-10

IC Document Collections

IC ID	Document Title	Status
261023	CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary Form and Instruction	New
250664	CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary Form and Instruction	Removed

ICR Details

OMB Control No: 0938-1314	ICR Reference No: 202307-0938-005
Status: Received in OIRA	Previous ICR Reference No: 202301-0938-017
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Quality Payment Program (QPP)/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	Date Submitted to OIRA: 08/24/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2025
Responses	184,564	159,528
Time Burden (Hours)	715,450	713,860
Cost Burden (Dollars)	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-AV07	Proposed rulemaking	88 FR 52262	08/07/2023

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 52262	08/07/2023
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
CY 2023 Performance Period/2025 MIPS Payment Year Burden Summary	Appendix J, Appendix I, Appendix A, Appendix B1, Appendix D1, Appendix E1, Appendix F1, Appendix G1, Appendix H1, Appendix K1, Appendix L1, Appendix C1	Self-Nomination User Guide for Qualified Clinical Data Registries (QCDRs) and Qualified Registries ,   2023 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) ,   2023 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form) ,   2023 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option ,   Measures under Consideration 2022 (for the 2024 performance period), Data Template for Candidate Measures ,   2023 Peer Reviewed Journal Article Requirement Template ,   Promoting Interoperability Performance Category, 2023 Call for Measures Submission Form ,   Improvement Activities Performance Category, 2023 Call for Activities Submission Form ,   2022 MIPS Promoting Interoperability Hardship Exception Application Guide (for submission in CY 2023) ,   2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (for submission in CY2023 ,   2023 MVP Candidates: Instructions and Template ,   2022 Partial QP Election Form (for submission in CY 2023)
CY 2024 Performance Period/2026 MIPS Payment Year Burden Summary	Appendix A, Appendix B, Appendix C, Appendix D, Appendix E1, Appendix F1, Appendix G, Appendix H, Appendix I, Appendix J, Appendix K, Appendix L	2023 QCDR and Registry Self-nomination User Guide ,   2023 MVP Registration Form (New) ,   2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Guide (for submission in CY 2023) (previously Appendix J) ,   2023 Submission Form for Other Payer Requests for Other Payer Advanced Alternative Payment Model Determinations (Payer Initiated Submission Form) ,   Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative Payment Model Determinations (Eligible Clinician Initiated Submission Form) ,   2023 Submission Form for Requests for Qualifying Alternative Payment Model Participant (QP) Determinations under the All-Payer Combination Option ,   Measures under Consideration 2023 Data Template for Candidate Measures ,   2023 Peer Reviewed Journal Article Requirement Template ,   2023 MVP Candidates: Instructions and Template (previously Appendix K) ,   2022 Partial QP Election Form (for submission in CY 2023) (previously Appendix L) ,   Improvement Activities Performance Category, 2023 Call for Activities Submission Form (previously Appendix H) ,   2022 MIPS Promoting Interoperability Hardship Exception Application Guide (for submission in CY 2023) (previously Appendix I)

---

ICR Summary of Burden

	Total Request	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	184,564	159,528	1,284	0	23,752	0
Annual Time Burden (Hours)	715,450	713,860	-4,002	0	5,592	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: The changes in this CY 2024 collection of information request are associated with our August 7, 2023 (88 FR 52262) proposed rule (CMS-1784-P, RIN 0939-AV07). Overall, this iteration proposes to add 25,036 responses (from 159,528 to 184,564 responses) and 1,590 hours (from 713,860 to 715,450 hours). Please see sections 12 and 15 of this Supporting Statement for details. With respect to this information collection’s instruments, we are not proposing any changes to Appendices, A, B, C, and D. We have revised Appendices E1 and F1. We are removing Appendix G As a result of removing Appendix G, we have redesignated the remaining appendices. Additionally, we have added a new form under Appendix L, MVPs registration form, related to the ICR for MVP and subgroup registration. Please see Information Collection Instruments/Instructions under section 12 of this Supporting Statement for details.

---

Annual Cost to Federal Government: $182

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

---

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: 08/24/2023

---