Appendix E Measures under Consideration 2025 Data Template for Cand

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

Appendix E MUC 2025 Data Template for Candidate Measures

CY 2026 Performance Period/2028 MIPS Payment Year

OMB: 0938-1314

Document [pdf]

Download: pdf | pdf

OMB control number: 0938-1314
Expiration Date: 02/28/2027
Centers f or Medicare & Medicaid Services

Measures Under Consideration Entry/Review and Information Tool 2025 Data Template for Candidate Measures

Instructions:
1.

Bef ore accessing the CMS MERIT (Measures Under Consideration Entry/Review and Inf ormation Tool) online system, you are invited to complete
the measure template below by entering your candidate measure inf ormation in the column titled “Add Your Content Here.”
2. All rows that have an asterisk symbol * in the Field Label require a response, unless otherwise indicated in the template.
3. For each row, the “Guidance” column provides details on how to complete the template and what kinds of data to include. Unless otherwise
specif ied, the character limit f or text f ields in CMS MERIT is 8000 characters.
4. For check boxes, note whether the f ield is “select one” or “select all that apply.” You can click on the box to place or remove the “X.”
5. For all f ields, especially Numerator and Denominator, use plain text whenever possible. Please convert any special symbols, math expressions,
or equations to plain text (keyboard alphanumeric, such as + - * /).
6. Please ensure that if your measure includes Numerator Exclusions, Denominator Exclusions, or Denominator Exceptions, they are listed in their
designated locations and not solely identif ied in the Numerator or Denominator f ields. This practice is crucial f or maintaining the standardization of
the measure submission process.
7. For all f ree-text f ields: Be sure to spell out all abbreviations and def ine special terms at their f irst occurrence.
8. Numeric f ields are noted, where applicable, in the “Add Your Content Here” column.
9. Row numbers are f or convenience only and do not appear on the CMS MERIT user interf ace.
10. Send any questions to MMSsupport@battelle.org with the subject line “Pre-Rulemaking”.

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STEWARD or OWNER
Subsection
Steward or
Owner
Information
Steward or
Owner
Information
Steward or
Owner
Information

Row
001

n/a

Steward or
Owner
Information

Field Label

Guidance
Enter the current Measure Steward or Owner. Typically,
this is an organization or other agency/institution/entity
name.
Please provide the contact information of the measure
steward or owner.

ADD YOUR CONTENT HERE
See Appendix A.001 for list choices.
Copy/paste or enter your choices here:

*Did another federal agency

To answer the question, please confirm if any external
entities such as federal agencies, organizations,
subcontractors, or partners were involved in the
development of the measure. Simply respond with "Yes" if
there was any collaboration, or "No" if the development
was carried out independently by your team.

☐ Yes
☐ No

n/a

This is not a data entry field.

004

If you select “Yes” in Row
003, then Row 004 becomes
a required field. If you select
“No” in Row 003, then skip
to Row 005.

*List Collaborators in
Measure Development

If yes, please list all federal agencies, organizations,
subcontractors, or partners that participated in the
development of the measure.

Free text field

Measure
Developer
Information

005

*Is the Measure Developer

Please verify whether the measure developer is the same
entity as the measure steward or owner mentioned above.

☐ Yes
☐ No

n/a

This is not a data entry field.

Measure
Developer
Information
Submitter
Information

006

If different from Steward or Owner above, enter the
required contact information for the Measure Developer
listed above
Select “Yes” or “No.”

ADD YOUR CONTENT HERE

*Measure Steward or

Owner
002

*Measure Steward or

Owner Contact Information
003

or any other organizations,
subcontractors, or partners
participate in developing the
measure?

different than the steward
or owner?
If you select “Yes” in Row
005, then Row 006 becomes
a required field. If you select
“No” in Row 005, then skip
to Row 007.

*Measure Developer
Contact Information

007

Is primary submitter the
same as steward or owner?

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ADD YOUR CONTENT HERE

☐ Yes
☐ No

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Subsection
n/a

Row
n/a

Submitter
Information

008

*Primary Submitter Contact
Information

Submitter
Information
n/a

009

Secondary Submitter
Contact Information
If applicable, select from
drop-down menu “Other
MERIT users who will
contribute to this measure”

n/a

Field Label
If you select “No” in Row
007, then Row 008 becomes
a required field. If you select
“Yes” in Row 007, then skip
to Row 009.

n/a

Guidance

ADD YOUR CONTENT HERE
This is not a data entry field.

If different from Steward or Owner above: Last name, First
name; Affiliation; Telephone number; Email address. NOTE:
The primary and secondary submitters entered here do not
automatically have read/write/change access to modify this
measure in CMS MERIT. To request such access for others,
when logged into the CMS MERIT interface, navigate to
“About” and “Contact Us,” and indicate the name and email address of the person(s) to be added.
If different from name(s) above: Last name, First name;
Affiliation; Telephone number; Email address.
n/a

ADD YOUR CONTENT HERE

ADD YOUR CONTENT HERE
This is not a data entry field.

PROPERTIES
Subsection
Measure
Information

Row
010

Field Label

*Measure Title

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Guidance
Provide the measure title only (255 characters or less).
Put any program-specific identification (ID) number
under Characteristics, not in the title.
Note: Do not enter the CMIT ID, consensus-based entity
(endorsement) ID, former Jira MUC ID number, or any
other ID numbers here (see other fields below). The
Medicare program name should not ordinarily be part
of the measure title, because each measure record
already has a required field that specifies the Medicare
program. An exception would be if there are several
measures with otherwise identical titles that apply to
different programs. In this case, including or imbedding
a program name in the title (to prevent there being any
otherwise duplicate titles) is helpful. For additional
information on measure title, see the Measure
Specification tab on the CMS MMS Hub.

ADD YOUR CONTENT HERE
Free text field

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Subsection
Measure
Information

Row
011

n/a

Measure
Information

012

Measure
Information

013

Field Label

*Is any part of the measure
or use of the measure
proprietary and/or licensed?
If you select “Yes” in Row
011, then Rows 012 and 013
become required fields. If
you select “No” in Row 011,
then skip to Row 014.

*Are there any licensing

fees associated with the use
of or reporting of this
measure for either CMS or
Measured Entities?

*Proprietary and/or
Licensing Details

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Select ‘Yes’ or ‘No’

Guidance

Indicate whether there are any proprietary components
of the measure such as specifications, algorithms,
and/or software.
n/a

Select ‘Yes’ or ‘No’
Indicate whether there are any licensing fees associated
with the use or reporting of this measure for either
CMS or the measured entities.

If you answered "Yes" to either of the following
questions: "Is any part of the measure or use of the
measure proprietary and/or licensed?" or "Are there
any licensing fees associated with the use of or
reporting of this measure for either CMS or Measured
Entities?" please provide detailed information about
the proprietary components and/or licensing fees
required.

☐ Yes
☐ No

ADD YOUR CONTENT HERE

This is not a data entry field.

☐ Yes
☐ No

Free text field

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Subsection
Measure
Information

Row
014

Field Label

*Is the measure a
composite, survey, and/or a
paired measure?

Select all that apply.

Guidance

A composite measure contains two or more individual
measures, resulting in a single measure and a single
score. This includes index measures.

ADD YOUR CONTENT HERE
☐ Yes, this is a composite measure
☐ Yes, this is a survey measure
☐ Yes, this is a paired measure
☐ No, this is not a composite, survey, or a paired
measure

A survey measure refers to a type of performance
measure that is derived from data collected through
surveys.
Paired measures have different measure scores, but
results require them to be reported together to be
interpreted appropriately. Note: Individual measures
comprising a paired measure must be submitted
individually.

n/a

If you select “Yes, this is a
composite or survey
measure” in Row 014, then
Row 015 becomes a required
field. If you select “Yes, this
is a paired measure” in Row
014, then Rows 016-017
become required fields. If
you select “No, this is not a
composite, survey, or a
paired measure” in Row 014,
then skip to Row 018.

Measure
Information

015

*Enter titles of each

component or survey-based
measure

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If you choose composite or survey, click save and a
"Component or Survey-Based Measure" tab will
appear at the top of the screen. Navigate to this
screen to answer the component and survey-based
questions.
n/a

Please list each title for each specific component or
survey-based measure.

This is not a data entry field.

Free text field

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Subsection
Measure
Information

Row
016

Measure
Information

017

n/a

Measure
Information

018

Field Label

*How many measures are
intended to be paired with
this measure?
*What are the titles of all

measures that should be
paired with this measure?

If you are submitting a
composite or survey
measure, Row 018 in MERIT
will enable you to input
information for each
component or survey-based
measure included in your
submission.

*Measure Description

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Guidance
How many other measures are intended to be paired
with this measure? Do not include this measure in the
count.

ADD YOUR CONTENT HERE
Numeric field

Please enter the measure titles for all other measures
that should be paired with this measure. Do not include
this measure in the list. Please enter the measure titles
separated by a semicolon, and do not enter any
additional information in this field.
n/a

Free text field

Provide a brief description of the measure. For
additional information on measure description, see the
Measure Specification tab on the CMS MMS Hub.

Free text field

This is not a data entry field.

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Subsection
Measure
Information

Row
019

Field Label

*Select the Medicare
program(s) for which the
measure is being submitted.

Guidance
Select all that apply. Please note, measures specified
and intended for use at more than one level of analysis
must be submitted separately for each level of analysis
(e.g., individual clinician, facility).
If you choose multiple programs for this submission,
please ensure the programs fall under the same level of
analysis. If you choose multiple programs and need
guidance as to whether your selection represents
multiple levels of analysis, please contact
MMSSupport@battelle.org. There is functionality
within CMS MERIT to decrease the data entry process
for multiple submissions of the same measure. Please
reach out to MMSSupport@battelle.org
for guidance and support.
If you are submitting for MIPS, there are two choices of
program. Do NOT enter both MIPS-Quality and MIPSCost for the same measure. Choose MIPS-Quality for
measures that pertain to quality and/or efficiency.
Choose MIPS-Cost only for measures that pertain to
cost.
If you are submitting a measure to the Hospital
Inpatient Quality Reporting Program and your measure
is an electronic Clinical Quality Measure (eCQM), it is
also required to be submitted to the Medicare
Promoting Interoperability Program.

n/a

If you select “Merit-based
Incentive Payment System Quality” in Row 019, then
Row 020 becomes an
optional field. If you do not
select “Merit-based
Incentive Payment System Quality” in Row 019, then
skip to Row 021.

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n/a

ADD YOUR CONTENT HERE
☐ Ambulatory Surgical Center Quality Reporting
Program
☐ End-Stage Renal Disease (ESRD) Quality Incentive
Program
☐ Home Health Quality Reporting Program
☐ Hospice Quality Reporting Program
☐ Hospital Inpatient Quality Reporting Program
☐ Hospital Outpatient Quality Reporting Program
☐ Hospital Readmissions Reduction Program
☐ Hospital Value-Based Purchasing Program
☐ Hospital-Acquired Condition Reduction Program
☐ Inpatient Psychiatric Facility Quality Reporting
Program
☐ Inpatient Rehabilitation Facility Quality Reporting
Program
☐ Long-Term Care (LTC) Hospital Quality Reporting
Program
☐ Medicare Promoting Interoperability Program
☐ Medicare Shared Savings Program
☐ Merit-based Incentive Payment System-Cost
☐ Merit-based Incentive Payment System-Quality
☐ Part C Star Ratings
☐ Part D Star Ratings
☐ Prospective Payment System-Exempt Cancer
Hospital Quality Reporting Program
☐ Rural Emergency Hospital Quality Reporting
Program
☐ Skilled Nursing Facility Quality Reporting Program
☐ Skilled Nursing Facility Value-Based Purchasing
Program
This is not a data entry field.

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Subsection
Measure
Information

Row
020

Measure
Information

021

Field Label
MIPS Quality: Identify any
links with related Cost
measures and Improvement
Activities
* Completed Stage(s) of
Development

Guidance
Where available, provide description of linkages and a
rationale that correlates this MIPS quality measure to
other performance category measures and activities.

ADD YOUR CONTENT HERE
Free text field

Select all stages of development that have been
completed. There are five stages in the Measure
Lifecycle: conceptualization; specification; testing;
implementation; and use, continuing evaluation, and
maintenance. Measure conceptualization is the first
stage; however, the stages are not necessarily
sequential. Instead, the stages are iterative and can
occur concurrently.

☐ Measure Conceptualization
☐ Measure Specification
☐ Measure Testing
☐ Measure Use, Continuing Evaluation &
Maintenance

The measure conceptualization stage initiates
information gathering and business case development.
The measure specification stage involves establishing
the basic elements of the measure, including the
numerator, calculation algorithm, and data source
identification.
The measure testing stage examines the specifications,
usually with a limited number of real settings, to make
sure the measure is scientifically acceptable and
feasible.
Measure specification and measure testing are
iterative.

n/a

If you select only “Measure
Conceptualization” and/or
“Measure Specification” in
Row 021, then Row 022
becomes a required field. If
your selections include
“Measure Testing” or
“Measure Use, Continuing
Evaluation & Maintenance”
in Row 021, then skip to Row
023.

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For additional information regarding stage of
development, see the Blueprint Measure Lifecycle on
the CMS MMS Hub.
n/a

This is not a data entry field.

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Subsection
Measure
Information

Measure
Information

Row
022

023

Field Label

*Stage of Development
Details

*Level of Analysis

Guidance
If testing is not yet completed, describe when testing is
planned (i.e., specific dates), what type of testing is
planned (e.g., alpha, beta) as well as the types of
facilities in which the measure will be tested.
For additional information, see the Blueprint Measure
Lifecycle on the CMS MMS Hub.
Select one. Select the level of analysis at which the
measure is specified and intended for use. If the
measure is specified and intended for use at more than
one level, submit the other levels separately. Any
testing results provided in subsequent sections of this
submission must be conducted at the level of analysis
selected here.
For submission to the MIPS-Quality program, you must
report, at minimum, the results of individual clinicianlevel testing.

ADD YOUR CONTENT HERE
Free text field

☐ Accountable Care Organization
☐ Clinician: Group
☐ Clinician: Individual
☐ Clinician: Individual and Group
☐ Facility
☐ Health plan
☐ Integrated Delivery System
☐ Medicaid program (e.g., Health Home or 1115)
☐ Population: Community, County or City
☐ Population: Regional and State

If testing is performed at both clinician-individual and
clinician-group levels of analysis, you may select
“Clinician: Individual and Group.” Please submit results
of individual clinician-level testing in this form and
group-level testing results in an attachment.
For submission to the MIPS-Cost program, clinician
group-level testing is sufficient.

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Subsection
Measure
Information

Row
024

Measure
Information

n/a

Field Label

Guidance

*In which setting(s) was this
measure tested?

Select all that apply.

025

*Multiple Scores

n/a

If you select “Yes” in Row
025, then Rows 026-028
become required fields. If
you select, “No”, then skip to
Row 029.

Does the submitter recommend that more than one
measure score be separately reported for this measure
(e.g., 7- and 30-day rate, rates for different procedure
types, etc.)? This does not include index measures,
where component measure scores result in one overall
index score. Note: If “Yes”, please describe one score
only in this form. Submit separate attachments for each
of the other scores.
n/a

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ADD YOUR CONTENT HERE
☐ Ambulatory surgery center
☐ Ambulatory/office-based care
☐ Behavioral health clinic
☐ Birthing Centers
☐ Community hospital
☐ Dialysis facility
☐ Emergency department
☐ Emergency Medical Services/Ambulance
☐ Federally qualified health center (FQHC)
☐ Health and Drug Plans
☐ Hospital: critical access
☐ Hospital outpatient department (HOD)
☐ Home health
☐ Hospice
☐ Hospital inpatient acute care facility
☐ Inpatient psychiatric facility
☐ Inpatient rehabilitation facility
☐ Long-term care hospital
☐ Nursing home
☐ PPS-exempt cancer hospital
☐ Skilled nursing facility
☐ Veterans Health Administration facility
☐ Not yet tested
☐ Other (enter here):
☐ Yes
☐ No

This is not a data entry field.

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Subsection
Measure
Information

Row
026

Field Label

*Measures with Multiple

Guidance
How many measure scores are included in this
measure?

ADD YOUR CONTENT HERE
Numeric field

Measure
Information

027

*Measures with Multiple

Please enter the name of the score described in this
MERIT form.

Free text field

Measure
Information

028

*Measures with Multiple
Scores: Names of Scores

Please enter the names of all additional scores included
in this measure but not described in this MERIT form.
Please enter the names separated by a semicolon and
do not enter any additional information in this field.
n/a

Free text field

n/a

Measure
Information

029

The upper portion of a fraction used to calculate a rate,
proportion, or ratio. An action to be counted as
meeting a measure's requirements.
For additional information on exclusions/exceptions,
see the Measure Testing page on the CMS MMS Hub. If
not applicable, enter 'N/A.'
The lower part of a fraction used to calculate a rate,
proportion, or ratio. The denominator is associated
with a given population that may be counted as eligible
to meet a measure’s inclusion requirements.
For additional information on exclusions/exceptions,
see the Measure Testing page on the CMS MMS Hub. If
not applicable, enter 'N/A.'
For additional information on exclusions/exceptions,
see the Measure Testing page on the CMS MMS Hub. If
not applicable, enter 'N/A.'
Briefly describe the rationale for the measure and/or
the impact the measure is anticipated to achieve.
Details about the evidence to support the measure will
be captured in the Evidence section.

Free text field

Measure
Information

030

*Numerator Exclusions

Measure
Information

031

*Denominator

Measure
Information

032

*Denominator Exclusions

Measure
Information

033

*Denominator Exceptions

Measure
Information

034

*Briefly describe the

Scores: Number of Scores
Scores: Names of Score
Reported in MERIT Form

If you are submitting a
composite or survey
measure, Rows 029-034 in
MERIT will enable you to
input information for each
component or survey-based
measure included in your
submission.

*Numerator

rationale for the measure

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This is not a data entry field.

Free text field
Free text field

Free text field
Free text field
Free text field

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Subsection
Measure
Implementa
tion

Row
035

Field Label

*Feasibility of Data
Elements

Guidance
Select one. Select the extent to which the specified
data elements are available in electronic fields.
Electronic fields should include a designated location
and format for the data in claims, EHRs, registries, etc.
• Select “ALL data elements are in defined fields in
electronic sources” if the data elements needed to
calculate the measure are all available in discrete and
electronically defined fields.
• Select “Some data elements are in defined fields in
electronic sources” if the data elements needed to
calculate the measure are not all available in discrete
and electronically defined fields.
• Select “No data elements are in defined fields in
electronic sources” if none of the data elements
needed to calculate the measure are available in
discrete and electronically defined fields.
• Select “Not applicable" ONLY for CAHPS measures.
• Select “Unable to Determine” ONLY if a feasibility
assessment has not yet been completed.

n/a

If you select “ALL data
elements are in defined
fields in electronic sources”
or “Some data elements are
in defined fields in electronic
sources” in Row 035, then
Row 036 becomes a required
field, otherwise, skip to row
037.

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For a PRO-PM, select the most appropriate option
based on the data collection format(s).
n/a

ADD YOUR CONTENT HERE
☐ ALL data elements are in defined fields in electronic
sources
☐ Some data elements are in defined fields in
electronic sources
☐ No data elements are in defined fields in electronic
sources
☐ Not applicable (applies only for CAHPS measures)
☐ Unable to determine (applies only if a feasibility
assessment has not yet been completed)

This is not a data entry field.

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Subsection
Measure
Implementa
tion

Row
036

Field Label

*USCDI Data Elements

Guidance
Select one. Indicate the extent to which the data
elements that are in defined fields in electronic sources
align with the current version of the United States Core
Data for Interoperability (USCDI) or USCDI+ Quality
draft standard definitions.
For more information about USCDI, please refer to the
HealthIT.gov website.

ADD YOUR CONTENT HERE
☐ ALL data elements align with USCDI/USCDI+ Quality
standard definitions
☐ Some data elements align with USCDI/USCDI+
Quality standard definitions
☐ None of the data elements align with USCDI/USCDI+
Quality standard definitions
☐ USCDI/USCDI+ Quality alignment not assessed

For more information about USCDI+ Quality, please
refer to the HealthIT.gov website.

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Subsection
Measure
Implementa
tion

Row
037

Field Label

Measure
Implementa
tion

n/a

If you select "Combination"
in Row 037, then Row 038
becomes a required field;
otherwise, skip to Row 039.

Measure
Implementa
tion

038

*Combination measure:

*Method of Measure
Calculation

Methods of calculation

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Guidance
Select one. Select the method used to calculate
measure scores for the version of the measure
proposed in this submission form. Please review
guidance before making selections:
• Select “Electronically Derived Administrative Data
(Claims and/or Non-Claims)” if the measure can be
calculated exclusively from administrative data
submitted electronically for billing or other purposes.
• Select “eCQM” if the measure is exclusively specified
and formatted to use data from electronic health
record (EHRs) and/or health information technology
systems, using the Quality Data Model (QDM) to
define the data elements and Clinical Quality
Language (CQL) to express measure logic.
• Select “Other digital method” if the measure does
not meet the definition of an eCQM as described
above, but can be calculated electronically (e.g.,
registry, MDS, OASIS).
• Select “Manual abstraction” if all data elements in
the measure requires manual review of records,
paper-based billing, or manual calculation (e.g.,
CAHPS).
• Select “Combination” if two or more types of data
sources are required to calculate the measure score.
For all other measures that rely on patient surveys
(e.g., PRO-PMs), select the option that best describes
the way the measure is calculated. For example, if a
patient survey is collected electronically and does
not require manual abstraction, select "Other digital
method" or "eCQM" depending on where the data
are collected.
n/a

ADD YOUR CONTENT HERE
☐ Electronically Derived Administrative Data (Claims
and/or Non-Claims)
☐ eCQM
☐ Other digital method
☐ Manual abstraction
☐ Combination

Select all that apply. A minimum of two options must
be selected.

☐ Electronically Derived Administrative Data (Claims
and/or Non-Claims)
☐ eCQM
☐ Other digital method
☐ Manual abstraction

This is not a data entry field.

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Subsection
Measure
Implementa
tion

Row
039

Field Label

*How is the measure
expected to be reported to
the program?

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Guidance
This is the anticipated data submission method. Select
all that apply. Use the “Submitter Comments” field to
specify or elaborate on the type of reporting data, if
needed to define your measure.

ADD YOUR CONTENT HERE
☐ eCQM
☐ Clinical Quality Measure (CQM)
☐ Claims
☐ Web interface
☐ Other (enter here):

1/30/2025

Subsection
Burden

Row
040

Field Label

*Did the provider workflow
have to be modified to
collect additional data
needed to report the
measure?

Select one.

Guidance

Select “Yes” if workflow modifications impose
moderate to significant additional data entry burden on
a clinician or other provider to collect the data
elements to report the measure because data are not
routinely collected during clinical care, OR EHR
interface changes were necessary.

ADD YOUR CONTENT HERE
☐ Yes
☐ No
☐ Not applicable
☐ Unable to determine

Select “No” if workflow modifications impose no or
limited additional data entry burden on a clinician or
other provider to collect the data elements to report
the measure because data are routinely collected
during the clinical care, AND no EHR interface changes
were necessary.
Select "Not applicable" if the measure imposes no data
entry burden on the clinician or provider because:
A) the measure is calculated by someone other than
the clinician or provider AND uses data that are
routinely generated (i.e., administrative data and
claims), OR
B) the data are collected by someone other than the
clinician or provider (e.g., CAHPS), OR
C) the measure repurposes existing data sets to
calculate a measure score (e.g., HEDIS).
Select "Unable to determine” if a workflow analysis was
not completed and/or it cannot be determined whether
the workflow modifications impose additional data
entry burden to collect data needed to report the
measure.

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Subsection
Groups

Row
041

Field Label

*Is this measure an
electronic clinical quality
measure (eCQM)?

Guidance
Select 'Yes' or 'No'. If your answer is yes, CMS ID must
be provided below. For more information on eCQMs,
visit the Measure Authoring Development Integrated
Environment (MADiE) website.

☐ Yes
☐ No

ADD YOUR CONTENT HERE

If you select "yes" to this question and are submitting
to the Hospital Inpatient Quality Reporting Program,
you are also required to submit this measure to the
Medicare Promoting Interoperability Program.
Groups

n/a

Groups

042

If you select “Yes” in Row
041, then Rows 042-044
become required fields. If
you select “No” in Row 041,
then skip to Row 045.

*CMS ID found in MADiE

n/a

This is not a data entry field.

CMS encourages all submitters to submit both Quality
Data Model (QDM) and Fast Health Interoperability
Resources (FHIR) specifications, where available.

ADD YOUR CONTENT HERE

For QDM specifications, you must attach the eCQM
specification exported from MADiE, test cases exported
from MADiE, with 100% coverage/100% passing both
QRDA and Excel format), attestation that value sets are
published in Value Set Authority Center (VSAC), and
feasibility scorecard.
For FHIR specifications, you must attach the MADiE
output of the FHIR specifications using QI-Core 4.1.1 or
QI-Core STU 6, MADiE output of the QI-Core 4.1.1 or QiCore STU 6 compliant test cases (QI-Core version should
align between specification and test cases), and
attestation to value sets published in VSAC. Additional
Feasibility scorecard is not required at this time.
If not an eCQM, or if MAT number is not available,
enter 0.

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Subsection
Groups

Row
043

Groups

044

Field Label

*If eCQM, does the measure
have a Health Quality
Measures Format (HQMF)
specification in alignment
with the latest HQMF and
eCQM standards, and does
the measure align with
Clinical Quality Language
(CQL),Quality Data Model
(QDM), Fast Health
Interoperability Resources
(FHIR) and Quality
Improvement Core (QICore)?

n/a

☐ Yes
☐ No

ADD YOUR CONTENT HERE

*Number of unique EHR

Enter the number of unique EHR vendors represented
in the dataset to demonstrate that measure data
elements are valid and that the measure score can be
accurately calculated across different systems (e.g.,
Epic, Cerner, etc.).

Numeric field

If you are submitting a
composite or survey
measure, Rows 045-063 in
MERIT will enable you to
input information for each
component or survey-based
measure included in your
submission.

n/a

This is not a data entry field.

vendors represented in
testing dataset

n/a

Guidance
Select 'Yes' or 'No'. For additional information on HQMF
standards, visit the eCQI Resource Centers HQMF page.

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Subsection
Measure Score
Level
(Accountable
Entity Level)
Testing

Row
045

Field Label

*Reliability

Guidance
Indicate whether reliability testing was conducted for
the accountable entity-level measure scores.
Acceptable reliability tests include signal-to-noise (or
inter-unit reliability) or random split-half correlation.
For more information on accountable entity-level
reliability testing, refer to the Blueprint content on the
CMS Measures Management System (MMS) Hub.

☐ Yes
☐ No

ADD YOUR CONTENT HERE

Select “Yes” if acceptable accountable entity-level
reliability testing has been completed as of submission
of this form.
Select “No” if you are not able to provide the results of
acceptable accountable entity-level reliability testing in
this submission. If testing results are incomplete, or if
you are submitting a different type of reliability testing,
provide as an attachment.
Note: This section refers to the reliability of the
accountable entity-level measure scores in the final
performance measure. For testing of surveys or patient
reported tools, refer to the Patient-Reported Data
section. Note: for MIPS-Quality submissions, please
provide individual clinician-level results. If the measure
was also tested at the clinician group level, you may
include those results in an attachment.
n/a

n/a

If you select “Yes” in Row
045, then Rows 046-054
becomes required fields. If
you select “No” in Row 045,
then skip to Row 055.

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This is not a data entry field.

n/a

1/30/2025

Subsection
Measure Score
Level
(Accountable
Entity Level)
Testing

Row
046

Field Label

*Reliability: Type of analysis

Select all that apply.

Guidance

Signal-to-noise (or inter-unit reliability) is the precision
attributed to an actual construct versus random
variation (e.g., ratio of between unit variance to total
variance) (Adams J. The reliability of provider profiling:
a tutorial. Santa Monica, CA: RAND; 2009.).

ADD YOUR CONTENT HERE
☐ Signal-to-Noise (e.g., Beta-Binomial, Mixed Logistic
Regression)
☐ Random Split-Half Correlation

Random split-half correlation is the agreement
between two measures of the same concept, using data
derived from split samples drawn from the same entity
at a single point in time.
n/a

n/a

If you select “Signal-toNoise” in Row 046, then
Rows 047-050 become
required fields. If you select,
“Random Split-Half
Correlation” in Row 046,
then Rows 051-054 become
required fields.

n/a

This is not a data entry field.

Measure Score
Level
(Accountable
Entity Level)
Testing

047

* Signal-to-Noise: Level of

Select the level of analysis at which the signal-to-noise
analysis was conducted. If the measure is specified and
intended for use at more than one level, ensure the
results in this section are at the same level of analysis
selected in the Measure Information section of this
form.

☐ Accountable Care Organization
☐ Clinician – Group
☐ Clinician – Individual
☐ Facility
☐ Health plan
☐ Integrated Delivery System
☐ Medicaid program (e.g., Health Home or 1115)
☐ Population: Community, County or City
☐ Population: Regional and State

Analysis

For MIPS-Quality submissions, you must report the
results of individual clinician-level testing. If group-level
testing is available, you may submit those results as an
attachment.
For submission to the MIPS-Cost program, clinician
group-level testing is sufficient.
Measure Score
Level
(Accountable
Entity Level)
Testing

048

* Signal-to-Noise: Sample

size

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Indicate the number of accountable entities sampled to
test the final performance measure. Note that this field
is intended to capture the number of measured entities
and not the number of individual patients or cases
included in the sample.

Numeric field

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Subsection
Measure Score
Level
(Accountable
Entity Level)
Testing

Row
049

Measure Score
Level
(Accountable
Entity Level)
Testing

050

Measure Score
Level
(Accountable
Entity Level)
Testing

051

Field Label

Guidance
Indicate the median result for the signal-to-noise
analysis used to assess accountable entity level
reliability. Results should range from 0.00 to 1.00.
Calculate reliability as the measure is intended to be
implemented (e.g., after applying minimum
denominator requirements, appropriate type of setting,
provider, etc.).

ADD YOUR CONTENT HERE
Numeric field

* Signal-to-Noise:
Interpretation of results

Describe the type of statistic and interpretation of the
results (e.g., low, moderate, high). Provide the
distribution of signal-to-noise results across measured
entities (e.g., min, max, percentiles). List accepted
thresholds referenced and provide a citation. If
applicable, include the precision of the statistical result
(e.g., 95% confidence interval) and/or an assessment of
statistical significance (e.g., p-value).

Free text field

*Random Split-Half

Select the level of analysis at which the random splithalf analysis was conducted. If the measure is specified
and intended for use at more than one level, ensure the
results in this section are at the same level of analysis
selected in the Measure Information section of this
form.

* Signal-to-Noise: Median
Statistical result

Correlation: Level of Analysis

052

*Random Split-Half
Correlation: Sample size

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Indicate the number of accountable entities sampled to
test the final performance measure. If number varied
by sample, use the largest number of measured
entities. Note that this field is intended to capture the
number of measured entities and not the number of
individual patients or cases included in the sample.

Numeric field

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Subsection
Measure Score
Level
(Accountability
Entity Level)
Testing

Row
053

Measure Score
Level
(Accountability
Entity Level)
Testing

054

Measure Score
Level
(Accountability
Entity Level)
Testing

055

Field Label

Guidance
Indicate the statistical result for the random split-half
correlation analysis used to assess accountable entity
level reliability. Results should range from -1.00 to 1.00.
Calculate reliability as the measure is intended to be
implemented (e.g., after applying minimum
denominator requirements, appropriate type of setting,
provider, etc.).

ADD YOUR CONTENT HERE
Numeric field

*Random Split-Half
Correlation: Interpretation
of results

Describe the type of statistic and interpretation of the
results (e.g., low, moderate, high). List accepted
thresholds referenced and provide a citation. If
applicable, include the precision of the statistical result
(e.g., 95% confidence interval) and/or an assessment of
statistical significance (e.g., p-value).

Free text field

*Empiric Validity

Indicate whether empiric validity testing was conducted
for the accountable entity-level measure scores. For
more information on accountable entity level empiric
validity testing, refer to the Blueprint content on the
CMS MMS Hub.

☐ Yes
☐ No

*Random Split-Half
Correlation: Statistical result

Note: This section refers to the empiric validity of the
accountable entity level measure scores in the final
performance measure. Refer to the Patient-Reported
Data section for testing of surveys or patient reported
tools.
Note: for MIPS-Quality submissions, please provide
individual clinician-level results. If the measure was also
tested at the clinician group level, you may include
those results in an attachment.
n/a

n/a

If you select “Yes” in Row
055, then Rows 056-059
become required fields. If
you select “No” in Row 055,
then skip to Row 060.

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n/a

This is not a data entry field.

1/30/2025

Subsection
Measure Score
Level
(Accountable
Entity Level)
Testing

Row
056

Field Label

*Empiric Validity: Level of
Analysis

Guidance
Select the level of analysis at which the empiric validity
analysis was conducted. If the measure is specified and
intended for use at more than one level, ensure the
results in this section are at the same level of analysis
selected in the Measure Information section of this
form.
For MIPS-Quality submissions, you must report the
results of individual clinician-level testing. If group-level
testing is available, you may submit those results as an
attachment.

ADD YOUR CONTENT HERE
☐ Accountable Care Organization
☐ Clinician – Group
☐ Clinician – Individual
☐ Facility
☐ Health plan
☐ Integrated Delivery System
☐ Medicaid program (e.g., Health Home or 1115)
☐ Population: Community, County or City
☐ Population: Regional and State

For submission to the MIPS-Cost program, clinician
group-level testing is sufficient.

*Empiric Validity: Sample

Numeric field

058

*Empiric Validity: Methods
and findings

Describe the methods used to assess accountable entity
level validity. Describe the comparison groups or
constructs used to verify the validity of the measure
scores, including hypothesized relationships (e.g.,
expected to be positively or negatively correlated).
Describe your findings for each analysis conducted,
including the statistical results and the strongest and
weakest results across analyses. If applicable, include
the precision of the statistical result(s) (e.g., 95%
confidence interval) and/or an assessment of statistical
significance (e.g., p-value). If methods and results
require more space, include as an attachment.

Free text field

059

*Empiric Validity:

Indicate whether the statistical result affirmed the
hypothesized relationship for the analysis conducted.

☐ Yes
☐ No

Measure Score
Level
(Accountability
Entity Level)
Testing

057

Measure Score
Level
(Accountability
Entity Level)
Testing

Measure Score
Level
(Accountable
Entity Level)
Testing

size

Interpretation of results

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Subsection
Measure Score
Level
(Accountable
Entity Level)
Testing

Row
060

Field Label

*Face validity

Guidance
Indicate if a vote was conducted among experts and
patients/caregivers on whether the final performance
measure scores can be used to differentiate good from
poor quality of care.

☐ Yes
☐ No

ADD YOUR CONTENT HERE

Select “No” if experts and patients/caregivers did not
provide feedback on the final performance measure at
the specified level of analysis or if the feedback was
related to a property of the measure unrelated to its
ability to differentiate performance among measured
entities.
This item is intended to assess whether face validity
testing was conducted on the final performance
measure and is not intended to assess whether patientreported surveys or tools have face validity. Survey item
testing results can be provided in an attachment and
described in the Patient-Reported Data Section.

n/a

Measure Score
Level
(Accountable
Entity Level)
Testing
Measure Score
Level
(Accountable
Entity Level)
Testing

061

If you select “Yes” in Row
060, then Rows 061-063
become required fields. If
you select “No” in Row 060,
then skip to Row 064.

n/a

This is not a data entry field.

*Face validity: Total number

Indicate the number of experts and patients/caregivers
who voted on face validity (specifically, whether the
measure could differentiate good from poor quality
care among accountable entities).

Numeric field

*Face validity: Number of

Indicate the number of experts and patients/caregivers
who voted in agreement that the measure could
differentiate good from poor quality care among
accountable entities. If votes were conducted using a
scale, sum all responses in agreement with the
statement. Do not include neutral votes. If more than
one question was asked of the experts and
patients/caregivers, only provide results from the
question relating to the ability of the final performance
measure to differentiate good from poor quality care.

Numeric field

of voting experts and
patients/caregivers

062

experts and
patients/caregivers who
voted in agreement

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Subsection
Measure Score
Level
(Accountable
Entity Level)
Testing

Row
063

Field Label
Face validity: Interpretation

Guidance
Briefly explain the interpretation of the result, including
any disagreement with the face validity of the
performance measure.

ADD YOUR CONTENT HERE
Free text field

Subsection
Patient/Encou
nter Level
(Data Element
Level) Testing

Row
064

Field Label

Guidance
Indicate whether patient/encounter level testing of the
individual data elements in the final performance
measure was conducted (i.e., measure of agreement
such as kappa or correlation coefficient). Prior studies
of the same data elements may be submitted.

ADD YOUR CONTENT HERE
☐ Yes
☐ No
☐ Not applicable

*Patient/Encounter Level
Testing

• Select “Yes” if data element agreement was assessed
at the individual data element level as of submission
of this form.
• Select “No” if you are not able to provide the results
of data element agreement in this submission. If you
are submitting preliminary testing results or a
different type of data element testing, provide as an
attachment.
• Select “No” and skip to the Patient-Reported Data
section if data element testing was only conducted
for a survey or patient reported tool (e.g., internal
consistency) rather than data element agreement for
the final performance measure.
• Select “Not applicable” if the measure relies entirely
on administrative claims data.

n/a

If you select “Yes” in Row
064, then Rows 065-069
become required fields. If
you select “No” or “Not
applicable” in Row 064, then
skip to Row 070.

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Note: This section includes tests of both data element
reliability and validity.
n/a

This is not a data entry field.

1/30/2025

Subsection
Patient/Encou
nter Level
(Data Element
Level) Testing

Row
065

Field Label

Patient/Encou
nter Level
(Data Element
Level) Testing
Patient/Encou
nter Level
(Data Element
Level) Testing

066

*Sample Size

067

*Statistic Name

Patient/Encou
nter Level
(Data Element
Level) Testing

068

*Statistical Results:
Individual Data Element

*Type of Analysis

Guidance
Select all that apply. For more information on
patient/encounter level testing, refer to the Blueprint
content on the CMS MMS Hub.
Note: This section refers to the patient/encounter level
data elements in the final performance measure. Refer
to the Patient-Reported Data section for testing of
patient/encounter level data elements in surveys or
patient reported tools.
Indicate the number of patients/encounters sampled.

Select one. Indicate the statistic used to assess
agreement (e.g., percent agreement, kappa, positive
predictive value, etc.). If more than one type of statistic
was calculated, list the one that best depicts the
reliability and/or validity of the data elements in your
measure. Other statistics and results should be
provided in the “Interpretation of results” field or
provided as an attachment.
Indicate the single lowest critical data element result of
the statistic selected above. This field is intended to
capture the least reliable or least valid data element
included in the measure. Information about all critical
data elements should be provided in the
“Interpretation of results” field.

ADD YOUR CONTENT HERE
☐ Agreement between two manual reviewers
☐ Agreement between eCQM and manual reviewer
☐ Agreement between other gold standard and
manual reviewer

Numeric field

☐ Correlation coefficient
☐ Kappa
☐ Percent agreement
☐ Positive Predictive Value
☐ Sensitivity

Numeric field

If providing kappa or a correlation coefficient, results
should be between -1 and 1.
If providing percent agreement, sensitivity, or positive
predictive value, results should be between 0% and
100%. The percent value should be entered as a whole
number; for example, 70% would be entered as 70 and
NOT 0.7.
If not tested at the individual data element level, enter
9999.

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Subsection
Patient/Encou
nter Level
(Data Element
Level) Testing

Row
069

Field Label

*Interpretation of results

Guidance
Briefly describe the interpretation of results. Include a
list of all data elements tested including their
frequency, statistical results, and 95% confidence
intervals, as applicable. Include 95% confidence
intervals for the overall denominator and numerator
results, as applicable. Provide results broken down by
test site to demonstrate whether reliability/validity
varied between sites, if available. If more room is
needed and testing results are included in an
attachment, provide the name of the attachment and
location in the attachment.

ADD YOUR CONTENT HERE
Free text field

If any data element has low reliability or validity,
describe the anticipated impact and whether it could
introduce bias to measure scores. If there is variation in
reliability or validity scores across test sites/measured
entities, describe how this variation impacts overall
interpretation of the results.

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Subsection
PatientReported
Data

Row
070

n/a

PatientReported
Data

071

Field Label

*Does the performance
measure use survey or
patient-reported data?
If you select “Yes” in Row
070, then Rows 071 and 072
become required fields. If
you select “No” in Row 070,
then skip to Row 073.
*Survey level testing

methodology and results

Guidance
Indicate whether the performance measure utilizes
data from structured surveys or patient-reported tools.

☐ Yes
☐ No

ADD YOUR CONTENT HERE

n/a

This is not a data entry field.

List each survey or patient-reported outcome tool
accepted by the performance measure. Indicate
whether the tool(s) are being used as originally
specified and tested or if modifications are required. If
available, provide each survey or tool as a link or
attachment.

Free text field

Describe the mode(s) of administration available (e.g.,
electronic, phone, mail) and the number of languages
the survey(s) or tool(s) are available in.
Indicate whether any of the surveys or tools is
proprietary requiring licenses or fees for use.
Briefly describe the method used to psychometrically
test or validate the patient survey or patient-reported
outcome tool. (e.g., Cronbach’s alpha, ICC, Pearson
correlation coefficient, Kuder-Richardson test). If the
survey or tool was developed prior to the development
of the performance measure, describe how the
intended use of the survey or tools for the performance
measure aligns with the survey or tool as originally
designed and tested. Indicate whether the measure
uses all components within a tool, or only parts of the
tool. Summarize the statistical results and briefly
describe the interpretation of results.

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Subsection
PatientReported
Data

Row
072

n/a

Measure
Performance

073

Measure
Performance

074

Measure
Performance

075

Field Label

Guidance
Select all that apply. Survey instruments are expected
to be developed in Spanish, in addition to English.

ADD YOUR CONTENT HERE
☐ Survey instrument was developed in Spanish and
validated
☐ Survey instrument was developed in Spanish but not
yet validated
☐ Working on Spanish version of survey instrument
☐ There are no plans to develop a Spanish version of
survey instrument

n/a

This is not a data entry field.

*Measure performance type of score

Select one. Measure performance score type should be
at the level of accountable entity.

*Measure performance

Select one

*Number of accountable

Provide the number of accountable entities included in
the analysis of the distribution of performance scores.

☐ Categorical (e.g., measured entity scores yes/no,
pass/fail, or rating scale/score)
☐ Composite scale/non-weighted score
☐ Composite scale/weighted score
☐ Continuous variable (e.g., average)
☐ Count
☐ Frequency Distribution
☐ Proportion
☐ Rate
☐ Ratio
☐ Better performance = Higher score
☐ Better performance = Lower score
☐ Better performance = Score within a defined interval
☐ Passing score above a specified threshold defines
better performance
☐ Passing score below a specified threshold defines
better performance
Numeric field

*Spanish development of
the survey instrument.

If you are submitting a
composite or survey
measure, Rows 073-082 in
MERIT will enable you to
input information for each
component or survey-based
measure included in your
submission.

score interpretation

entities included in analysis

Please enter a single value and do not enter a range.
If unknown or not available, enter 9999.

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Subsection
Measure
Performance

Row
076

Measure
Performance

077

Measure
Performance

078

Field Label

Guidance
Provide the unit of accountable entities included in the
analysis of the distribution of performance scores.

ADD YOUR CONTENT HERE
Free text field

*Number of persons

Provide the number of persons included in the analysis
of the distribution of performance scores

Numeric field

*10th percentile

Provide the performance score at the 10th percentile
for the testing sample that is relevant to the intended
use of the measure.

Numeric field

*Number of accountable
entities: unit

If this is a proportion measure, provide the 10th
percentile score in percentage form, without the
symbol. For example, if the 10th percentile
performance score is 21.2%, enter 21.2 and not 0.212.

Measure
Performance

079

*50th percentile (median)

If a 10th percentile performance score is not available,
enter 9999.
Provide the median performance score (50th
percentile) for the testing sample that is relevant to the
intended use of the measure.

Numeric field

Please enter only one value in the response field and do
not enter a range of values.
If this is a proportion measure, provide the median
performance score in percentage form, without the
symbol. For example, if the median performance score
is 85.6%, enter 85.6 and not 0.856.
If a median performance score is not available, enter
9999.

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Subsection
Measure
Performance

Row
080

Field Label

*90th percentile

Guidance
Provide the performance score at the 90th percentile
for the testing sample that is relevant to the intended
use of the measure.

Numeric field

ADD YOUR CONTENT HERE

If this is a proportion measure, provide the 90th
percentile score in percentage form, without the
symbol. For example, if the 90th percentile
performance score is 85.6%, enter 85.6 and not 0.856.

Measure
Performance

081

*Additional measure

performance information

082

*Is there evidence for
statistically significant gaps
in measure score
performance among select
subpopulations of interest
defined by one or more
social risk factors?

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If a 90th percentile performance score is not available,
enter 9999.
Provide the following additional measure performance
information, as applicable:
- Mean performance score across accountable entities
in the test sample that is relevant to the intended use
of the measure.
- Minimum and maximum performance score for the
testing sample that is relevant to the intended use of
the measure.
- Standard deviation of performance scores for the
testing sample that is relevant to the intended use of
the measure.
- Passing score for the performance measure.
- Performance score’s defined interval, including upper
and lower limit of the performance score.
Select one. Social risk factors may include age, social,
economic, and geographic factors linguistic and cultural
context, sex, social relationships, residential and
community environments, Medicare/Medicaid dual
eligibility, insurance status (insured/uninsured),
urbanicity/rurality, disability, and health literacy.

Free text field

☐ Yes
☐ No
☐ Not tested

1/30/2025

Subsection
Importance

Row
083

n/a

Importance

084

Importance

085

Field Label

Guidance
Select one. Patients and/or caregivers can include any
of the following:
• Patients
• Primary caregivers
• Family
• Other relatives

ADD YOUR CONTENT HERE
☐ Yes
☐ No
☐ Not evaluated

n/a

This is not a data entry field.

*Description of input

Free text field

collected from
patients/caregivers
consulted

Describe the input collected from patient/caregivers
consulted about the measure, including the number of
patients/caregivers consulted and the number who
agreed that the measure is meaningful and produces
information that is valuable in making care decisions.

Description of input
collected from measured
entities.

Describe the input collected from measured entities, or
others such as consumers, purchasers, policy makers,
etc., using any of the following methods:

Free text field

*Meaningful to Patients. Did
the majority of
patients/caregivers
consulted agree that the
measure is meaningful
and/or produces
information that is valuable
to them in making their care
decisions?
If you select “Yes” in Row
083, then Row 084 becomes
a required field. If you select
“No” or “Not evaluated” in
Row 083, then skip to Row
085.

• Focus groups
• Structured interviews
• Surveys of potential users
Notes:
• This is separate from face validity testing of the
performance measure.

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Subsection
Background
Information

Row
086

Field Label

*What is the history or
background for including
this measure on the
current year MUC List?

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Select one

Guidance

Note:
•
“Medicare program” in the response options
refers only to the Medicare programs that
undergo the Pre-Rulemaking process. A full list of
these programs can be found on the CMS
Program Measure Needs and Priorities report.

ADD YOUR CONTENT HERE
☐ Measure currently used in a Medicare program
being submitted without substantive changes for a
new or different program
☐ Measure currently used in a Medicare program, but
the measure is undergoing substantive change
☐ Measure currently used in a Medicare program, but
the measure is undergoing substantive changes for a
new or different program
☐ Measure previously submitted to MAP or PRMR,
refined, and resubmitted per MAP or PRMR
recommendation
☐ New measure never reviewed by Measure
Applications Partnership (MAP) Workgroup, or PreRulemaking Measure Review (PRMR) or used in a
Medicare program
☐ Submitted previously but not included in MUC List

1/30/2025

Subsection
n/a

Row
n/a

Background
Information

087

Field Label
If you select “New measure
never reviewed by Measure
Applications Partnership
(MAP) Workgroup, or PreRulemaking Measure
Review (PRMR) or used in a
Medicare Program”,
“Submitted previously but
not included in MUC List”
or “Measure previously
submitted to MAP or
PRMR, refined, and
resubmitted per MAP or
PRMR recommendation” in
Row 086, then skip to Row
091. If you select “Measure
currently used in a
Medicare program being
submitted without
substantive changes for a
new or different program”,
“Measure currently used in
a Medicare program, but
the measure is undergoing
substantial change” or
“Measure currently used in
a Medicare program, but
the measure is undergoing
substantive changes for a
new or different program”
then Rows 087-090 become
required fields.

*Range of year(s) this
measure has been used by
Medicare Program(s).

2025 CMS MERIT DA TA TEMP LA TE

n/a

Guidance

Example: Hospice Quality Reporting (2012-2018)

ADD YOUR CONTENT HERE
This is not a data entry field.

Free text field

1/30/2025

Subsection
Background
Information

Row
088

Field Label

*What other federal
programs are currently
using this measure?

2025 CMS MERIT DA TA TEMP LA TE

Guidance
Select all that apply. These should be current use
programs only, not programs for the upcoming year’s
submittal.

ADD YOUR CONTENT HERE
☐ Ambulatory Surgical Center Quality Reporting
Program
☐ End-Stage Renal Disease (ESRD) Quality Incentive
Program
☐ Home Health Quality Reporting Program
☐ Hospice Quality Reporting Program
☐ Hospital Inpatient Quality Reporting Program
☐ Hospital Outpatient Quality Reporting Program
☐ Hospital Readmissions Reduction Program
☐ Hospital Value-Based Purchasing Program
☐ Hospital-Acquired Condition Reduction Program
☐ Inpatient Psychiatric Facility Quality Reporting
Program
☐ Inpatient Rehabilitation Facility Quality Reporting
Program
☐ Long-Term Care Hospital Quality Reporting Program
☐ Medicare Promoting Interoperability Program
☐ Medicare Shared Savings Program
☐ Merit-based Incentive Payment System-Cost
☐ Merit-based Incentive Payment System-Quality
☐ Part C Star Rating
☐ Part D Star Rating
☐ Prospective Payment System-Exempt Cancer
Hospital Quality Reporting Program
☐ Rural Emergency Hospital Quality Reporting Program
☐ Skilled Nursing Facility Quality Reporting Program
☐ Skilled Nursing Facility Value-Based Purchasing
Program
☐ Other (enter here):

1/30/2025

Subsection
Background
Information

Row
089

Background
Information

090

Previous
Measures

091

n/a

Field Label

*How will this measure
align with the same
measure(s) that are
currently used in other
federal programs?

*If this measure is being
submitted to meet a
statutory requirement, list
the corresponding statute

*Was this measure
published on a previous
year’s Measures Under
Consideration List?
If you select “Yes” in Row
091, then Rows 092-098
become required fields. If
you select “No” in Row 091,
then skip to Row 099.

2025 CMS MERIT DA TA TEMP LA TE

Guidance
Describe how this measure will achieve alignment with
the same measure(s) that are currently used in other
federal programs. Please include the names of the
same measure(s) that are used in other federal
programs and include the corresponding unique
identifier (e.g., federal program ID, CBE#, etc.), if
available.
Alignment is achieved when a set of measures works
well across care settings or programs to produce
meaningful information without creating extra work
for those responsible for the measurement. Alignment
includes using the same quality measures in multiple
programs when possible. It can also come from
consistently measuring important topics across care
settings.
List title and other identifying citation information. If
this measure is not being submitted to meet a
statutory requirement, enter N/A.

ADD YOUR CONTENT HERE
Free text field

Free text field

Select “Yes” or “No.” If yes, you are submitting an
existing measure for expansion into additional
Medicare programs or the measure has substantially
changed since originally published.

☐ Yes
☐ No

n/a

This is not a data entry field.

1/30/2025

Subsection
Previous
Measures

Row
092

Field Label

*In what prior year(s) was
this measure published on
the Measures Under
Consideration List?

2025 CMS MERIT DA TA TEMP LA TE

Guidance
Select all that apply. NOTE: If your measure was
published on more than one prior annual MUC List, as
you use the MERIT interface, click “Add Another
Measure” and complete the information section for
each of those years.

☐ 2011
☐ 2012
☐ 2013
☐ 2014
☐ 2015
☐ 2016
☐ 2017
☐ 2018
☐ 2019
☐ 2020
☐ 2021
☐ 2022
☐ 2023
☐ 2024

ADD YOUR CONTENT HERE

1/30/2025

Subsection
Previous
Measures

Row
093

Previous
Measures

094

Previous
Measures

095

Previous
Measures

096

Previous
Measures

097

Previous
Measures

098

Field Label

*What was the MUC ID for
the measure in each year?

*List the CMS CBE

workgroup(s) (MAP or
PRMR) in each year

*What were the programs

that MAP or PRMR
reviewed the measure for
in each year?

*What was the MAP or

PRMR recommendation in
each year?

*Why was the measure

not recommended by the
MAP or PRMR workgroups
in those year(s)?

*MAP or PRMR report

page number being
referenced for each year

2025 CMS MERIT DA TA TEMP LA TE

Guidance
List both the year and the associated MUC ID number
in each year. If unknown, enter N/A.

ADD YOUR CONTENT HERE
Free text field

List both the year and the associated workgroup name
in each year. MAP and PRMR workgroup options
include: Clinician; Hospital; Post-Acute Care/LongTerm Care; Coordinating Committee. Example:
“Clinician, 2014.”
List both the year and the associated Medicare
programs in each year.

Free text field

List the year(s), the program(s), and the associated
recommendation(s) in each year. Options: Support; Do
Not Support; Conditionally Support; Refine and
Resubmit.
Briefly describe the reason(s) if known.

Free text field

List both the year and the associated MAP report page
number for each year.

Free text field

1/30/2025

Subsection

Data Sources

Row

099

Field Label

*What data sources are
used for the measure?

Guidance

Select all that apply.
For example, if the measure uses survey data that are
captured both electronically and in paper format,
select the “Applications: Patient-Reported Health Data
or Survey Data (electronic)” from the “Digital Data
Sources” category and “Patient-Reported Health Data
or Survey Data (telephonic or paper-based)” from the
“Non-Digital Data Sources” category.
For more information about digital data sources,
please refer to the “Digital Data Sources” section of
the “dQMs - Digital Quality Measures” webpage on
the eCQI Resource Center.

n/a

If your selections in Row
099 only include digital
data sources, then skip to
Row 102. Otherwise, Row
100 becomes a required
field.

2025 CMS MERIT DA TA TEMP LA TE

n/a

ADD YOUR CONTENT HERE

☐ Digital-Administrative systems: Administrative Data
(non-claims)
☐ Digital-Administrative systems: Claims Data
☐ Digital-Applications: Patient-Generated Health Data
(e.g., home blood pressure monitoring)
☐ Digital-Applications: Patient-Reported Health Data or
Survey Data (electronic)
☐ Digital-Case Management Systems
☐ Digital-Clinical Registries
☐ Digital-Electronic Clinical Data (non-EHR) or Social
Needs Assessments
☐ Digital-Electronic Health Record (EHR) Data
☐ Digital-Health Information Exchanges (HIE) Data
☐ Digital-Instrument Data (e.g., medical devices and
wearables)
☐ Digital-Laboratory Systems Data
☐ Digital-Patient Portal Data
☐ Digital-Prescription Drug Monitoring Program Data
☐ Digital-Standardized Patient Assessment Data
(electronic)
☐ Digital-Other (enter here):
☐ Non-Digital-Paper Medical Records
☐ Non-Digital-Standardized Patient Assessments
(paper-based)
☐ Non-Digital-Patient-Reported Health Data or Survey
Data (telephonic or paper-based)
☐ Non-Digital-Other (enter here):
This is not a data entry field.

1/30/2025

Subsection

Data Sources

Row

100

Field Label

n/a

Data Sources

101

ADD YOUR CONTENT HERE

Select one. Indicate whether there is a version of the
measure that uses only digital data sources.

☐ Yes
☐ No

If you select “Yes” in Row
100, then skip to Row 102.
Otherwise, Row 101
becomes a required field.

n/a

This is not a data entry field.

Select one. Indicate whether there is a viable path for
the measure to be transitioned to an exclusively digital
format.

☐ Yes
☐ No

non-digital data source, is
there a version of this
measure that only uses
digital data
sources?
n/a

Guidance

*Because you selected a

*Path to Digital Format

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1/30/2025

CHARACTERISTICS
Subsection
General
Characteristics

Row
102

n/a

General
Characteristics

Field Label

*Measure Type

Guidance
Select only one type of measure. For definitions, visit the
“About Quality Measurement” page on the CMS MMS Hub.

ADD YOUR CONTENT HERE
☐ Cost/Resource Use
☐ Efficiency
☐ Intermediate Outcome
☐ Outcome
☐ PRO-PM or Patient Experience of Care
☐ Process
☐ Structure
This is not a data entry field.

n/a

103

If you select “PRO-PM or
Patient Experience of Care”
in Row 102, then Row 103
and Row 128 become
required fields. If not, then
skip to Row 104. If you
select “Outcome” in Row
102, then Row 128
becomes a required field.

*Assessment of patient
experience of care

Select one. Indicate whether this measure assesses patient
experience of care.

☐ Yes
☐ No

General
Characteristics

104

*Is this measure in the
CMS Measures Inventory
Tool (CMIT)?

Select Yes or No. Current measures can be found at the
CMS Measure Inventory Tool (CMIT) website.

☐ Yes
☐ No

n/a

If you select “Yes” in Row
104, then Row 105
becomes a required field. If
you select “No” in Row 104,
then skip to Row 106.

n/a

This is not a data entry field.

General
Characteristics

105

If the measure is currently in CMIT, enter the CMIT ID in the
format #####-##-X-PRGM. Current measures and CMIT IDs
can be found at the CMS Measure Inventory Tool (CMIT)
website.

ADD YOUR CONTENT HERE

*CMIT ID

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1/30/2025

Subsection
General
Characteristics

Row
106

Field Label
Alternate Measure ID

General
Characteristics

107

*What is the target

General
Characteristics

108

n/a

General
Characteristics

109

General
Characteristics

population of the measure?

*What one area of
specialty the measure is
aimed to, or which
specialty is most likely to
report this measure?
If you are submitting a
composite or survey
measure, Row 109 in
MERIT will enable you to
input information for each
component or surveybased measure included in
your submission.
*Evidence of performance

gap

110

*Unintended

consequences

2025 CMS MERIT DA TA TEMP LA TE

Guidance
This is an alphanumeric identifier (if applicable), such as a
recognized program ID number for this measure (20
characters or less). Examples: 199 GPRO HF-5; ACO 28;
CTM-3; PQI #08. DO NOT enter consensus-based entity
(endorsement) ID, CMIT ID, or previous year MUC ID in this
field.
What populations are included in this measure? E.g.,
Medicare Fee for Service, Medicare Advantage, Medicaid,
Children’s Health Insurance Program (CHIP), All Payer, etc.
Select the ONE most applicable area of specialty.

ADD YOUR CONTENT HERE
ADD YOUR CONTENT HERE

n/a

This is not a data entry field.

Evidence of a performance gap among the units of analysis
in which the measure will be implemented. Provide analytic
evidence that the units of analysis have room for
improvement and, therefore, that the implementation of
the measure would be meaningful.

Free text field

If you have lengthy text add the evidence as an
attachment, named to clearly indicate the related form
field.
Summary of potential unintended consequences if the
measure is implemented. Information can be taken from
the CMS consensus-based entity Consensus Development
Process (CDP) manuscripts or documents. If referencing
CDP documents, you must submit the document or a link to
the document, and the page being referenced.

Free text field
See Appendix A.108 for list choices. Copy/paste or
enter your choice(s) here:

Free text field

1/30/2025

Subsection
Evidence

Row
111

n/a

Field Label

*Type of evidence to
support the measure

If you select “Clinical
Guidelines or USPSTF (U.S.
Preventive Services Task
Force) Guidelines” in Row
111, then Rows 112-119
become required fields. If
you select “Peer-Reviewed
Systematic Review” in Row
111, then Rows 120 and
121 become required fields.
If you select “PeerReviewed Original
Research” in Row 111, then
Rows 122 and 123 become
required fields. If you select
“Empirical data” in Row
111, then Rows 124 and
125 become required fields.
If you select “Grey
Literature” in Row 111,
then Rows 126 and 127
become required fields.
If you are submitting a
composite or survey
measure, Rows 112-142 in
MERIT will enable you to
input information for each
component or surveybased measure included in
your submission.

2025 CMS MERIT DA TA TEMP LA TE

Guidance
Select all that apply. Refer to the Blueprint content on the
CMS MMS Hub and the Environmental Scan supplemental
material to obtain updated guidance.

ADD YOUR CONTENT HERE
☐ Clinical Guidelines or USPSTF (U.S. Preventive
Services Task Force) Guidelines
☐ Empirical data
☐ Grey Literature
☐ Peer-Reviewed Original Research
☐ Peer-Reviewed Systematic Review

n/a

This is not a data entry field.

n/a

This is not a data entry field.

1/30/2025

Subsection
Evidence

Row
112

Field Label

*Outline the clinical
guideline(s) supporting this
measure

Guidance
Provide a detailed description of which guideline(s) support
the measure and indicate for each, whether they are
evidence-based or consensus-based.

ADD YOUR CONTENT HERE
Free text field

Summarize the meaning/rationale of the guideline
statements that are being referenced, their relation to the
measure concept and how they support the measure
whether directly or indirectly, and how the guideline
statement(s) relate to the measure’s intended accountable
entity. Describe the body of evidence that supports the
statement(s) by describing the quantity, quality and
consistency of the studies that are pertinent to the
guideline statements/sentence. Quantity of studies
represent the number of studies and not the number of
publications associated with a study. If the statement is
advised by 3 publications reporting outcomes from the
same RCT at 3 different time points, this is considered a
single study and not 3 studies.
If referencing a standard norm which may or may not be
driven by evidence, provide the description and rationale
for this norm or threshold as reasoned by the guideline
panel.
If this is an outcome measure or PRO-PM, indicate how the
evidence supports or demonstrates a link between at least
one process, structure, or intervention and the outcome.
Document the criteria used to assess the quality of the
clinical guidelines such as those proposed by the Institute
of Medicine or ECRI Guideline’s Trust (see the Information
Gathering Overview on the CMS MMS Hub and the
Environmental Scan supplemental material section
addressing evidence review).
If there is lengthy text, describe the guidelines in an
evidence attachment.

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1/30/2025

Subsection
Evidence

Row
113

Field Label

*Guideline citation

Evidence

114

*List the guideline

statement that most
closely aligns with the
measure concept.

Evidence

115

*Is the guideline graded?

n/a

Evidence

116

If you select “Yes” in Row
115, then Rows 116-117,
and 119 become required
fields.

*List evidence grading

system used and all
categories and
corresponding definitions
for the evidence grading
system used to describe
strength of
recommendation in the
guideline.

2025 CMS MERIT DA TA TEMP LA TE

Guidance
Provide any of the following:
• Full citation for the primary clinical guideline in any
established citation style (e.g., AMA, APA, Chicago,
Vancouver, etc.)
• URL
• DOI or ISBN for clinical guideline document
If there are more than one statement from this clinical
guideline that may be relevant to this measure concept,
document the statement that most closely aligns with the
measure concept as it is written in the guideline document.
For example, Statement 1: In patients aged 65 years and
older who have prediabetes, we recommend a lifestyle
program similar to the Diabetes Prevention Program to
delay progression to diabetes. No more than one
statement should be written in the text box. All other
relevant statements should be submitted in a separate
evidence attachment.
A graded guideline is one which explicitly provides evidence
rating and recommendation grading conventions in the
document itself. Grades are usually found next to each
recommendation statement.
Select one.
n/a

ADD YOUR CONTENT HERE
☐ Citation (enter here)
☐ URL (enter here)
☐ DOI (enter here)
☐ Not available
Free text field

☐ Yes
☐ No

This is not a data entry field.

Insert the complete list of evidence grading systems,
grading categories, and category definitions used by the
clinical guideline (e.g., GRADE or USPSTF) to describe the
guideline statement’s strength of recommendation.

Free text field

If there is lengthy text, include details in a separate
evidence attachment.

1/30/2025

Subsection
Evidence

Row
117

Field Label

*For the guideline
statement that most
closely aligns with the
measure concept, what is
the associated strength of
recommendation?

Guidance
Select the associated strength of recommendation using
the convention used by the guideline developer.
Select one.

n/a

If you select “USPSTF Grade
D, Moderate or high
certainty that the service
has no net benefit or harm
outweighs benefit” in Row
117, then Row 118
becomes a becomes a
required field; otherwise,
skip to Row 119.

n/a

Evidence

118

*Is the selected guideline

Select one. Indicate whether the guideline statement
mentioned in “List the guideline statement that most
closely aligns with the measure concept” is used to
promote the practice of not performing a specific action,
process or intervention to support an inappropriate use or
inappropriate care measure.
Insert the complete list of grading categories and their
definitions.

statement used to support
an inappropriate use/care
measure?
Evidence

119

*List all categories and
corresponding definitions
for the evidence grading
system used to describe
level of evidence or level of
certainty in the evidence.

2025 CMS MERIT DA TA TEMP LA TE

ADD YOUR CONTENT HERE
☐ USPSTF Grade A, Strong recommendation or similar
☐ USPSTF Grade B, Moderate recommendation or
similar
☐ USPSTF Grade C or I, Conditional/weak
recommendation or similar
☐ Expert Opinion
☐ USPSTF Grade D, Moderate or high certainty that
service has no net benefit or harm outweighs benefit
☐ Best Practice Statement/Standard Practice
This is not a data entry field.

☐ Yes
☐ No

Free text field

1/30/2025

Subsection
Evidence

Evidence

Row
120

121

122

123

Field Label

*Briefly summarize the
peer-reviewed systematic
review(s) that inform this
measure concept

Guidance
Summarize the peer-reviewed systematic review(s) that
address this measure concept. For each systematic review,
provide the number of studies within the systematic review
that addressed the specifications defined in this measure
concept, indicate whether a study-specific risk of
bias/quality assessment was performed for each study, and
describe the consistency of findings. Number of studies is
not equivalent to the number of publications. If there are
three publications from a single cohort study cited in the
systematic review, report one when indicating the number
of studies. If this is an outcome measure or PRO-PM,
indicate how the evidence supports or demonstrates a
relationship between at least one process, structure, or
intervention with the outcome.

*Peer-reviewed systematic
review citation

If there is lengthy text, submit details via an evidence
attachment.
If more than one article was identified, provide at least one
of the following for one key article:
• Citation
• URL
• DOI

*Peer-reviewed original
research

Provide the complete list of citations with accompanying
DOI or URL in a separate attachment.
If the evidence synthesis provided to support this measure
concept was performed using peer-reviewed original
research articles, indicate whether a systematic search of
the literature was conducted.

*Peer-reviewed original
research citation

If “Yes,” please provide documentation of the search
strategy in an attachment (e.g., years searched, keywords
and search terms used, databases used, etc.).
If more than one article was identified, provide at least one
of the following for one key article:
• Citation
• URL
• DOI

ADD YOUR CONTENT HERE
Free text field

☐ Citation (enter here:)
☐ URL (enter here:)
☐ DOI (enter here:)
☐ Not available

☐ Yes
☐ No

☐ Citation (enter here:)
☐ URL (enter here:)
☐ DOI (enter here:)
☐ Not available

Provide the complete list of citations with accompanying
DOI or URL in a separate attachment.

2025 CMS MERIT DA TA TEMP LA TE

1/30/2025

Subsection
Evidence

Evidence

Row
124

125

126

Field Label

*Summarize the empirical
data

*Empirical data citation

*Summarize the grey

literature

Guidance
Provide a summary of the empirical data and how it
informs this measure concept. Describe the limitations of
the data. If this is an outcome measure or PRO-PM, indicate
how the evidence supports or demonstrates a link between
at least one process, structure, or intervention with the
outcome. Describe the source of the empirical data (e.g.,
peer-reviewed narrative literature review, published and
publicly available reports, internal data analysis, etc.).
If there is lengthy text, include details in a separate
evidence attachment.
If more than one empirical data was identified, provide at
least one of the following for one key empirical data:
• Citation
• URL
• DOI
Provide the complete list of citations with accompanying
DOI or URL in a separate attachment.
Provide a summary of the grey literature(s) used to inform
this measure concept. Describe the limitations of the data.
If this is an outcome measure or PRO-PM, indicate how the
evidence supports or demonstrates a link between at least
one process, structure, or intervention with the outcome.

ADD YOUR CONTENT HERE
Free text field

☐ Citation (enter here:)
☐ URL (enter here:)
☐ DOI (enter here:)
☐ Not available

ADD YOUR CONTENT HERE

Provide the complete list of citations with accompanying
DOI or URL in a separate attachment.
Evidence

127

*Grey literature citation

If more than one grey literature was identified, provide at
least one of the following for one key piece of evidence:
• Citation
• URL
• DOI

☐ Citation (enter here:)
☐ URL (enter here:)
☐ DOI (enter here:)
☐ Not available

Provide the complete list of citations with accompanying
DOI or URL in a separate attachment.

2025 CMS MERIT DA TA TEMP LA TE

1/30/2025

Subsection
Evidence

Row
128

Risk
Adjustment
and
Stratification

129

n/a

Risk
Adjustment
and
Stratification

130

Field Label

*Does the evidence discuss
a relationship between at
least one process,
structure, or intervention
with the outcome?
*Is the measure risk

adjusted?

If you select “Yes” in Row
129, then Row 130
becomes a become
required field. If you select
“No” in Row 129, then skip
to Row 140.

*Was a conceptual model

outlining the pathway
between patient risk
factors, quality of care, and
the outcome of interest
established?

n/a

If you select “Yes” in Row
130, then Row 131
becomes a required field. If
you select “No” in Row 130,
then skip to Row 132.

Risk
Adjustment
and
Stratification

131

*Were all key risk factors

identified in the conceptual
model available for testing?

2025 CMS MERIT DA TA TEMP LA TE

Guidance
Select “Yes” if the evidence that was discussed in the
evidence section demonstrate a relationship between at
least one process, structure, or intervention with the
outcome.
Indicate whether the final measure is risk adjusted.
Note that if you select “Yes,” you are encouraged to upload
documentation about the risk adjustment model as an
attachment.
n/a

Select “Yes” if a conceptual model was established based
on a review of published literature. The conceptual model
can be supplemented by other sources of information such
as expert opinion or empirical analysis.
Select “No” if a conceptual model was not established or
the conceptual model was based solely on expert opinion
or empirical analysis.
n/a

If some key risk factors were not available for testing or
inclusion in the risk model approach, select “No” and
describe the anticipated impact on measure scores (e.g.,
magnitude and direction of bias).

☐ Yes
☐ No

ADD YOUR CONTENT HERE

☐ Yes
☐ No

This is not a data entry field.

☐ Yes
☐ No

This is not a data entry field.

☐ Yes
☐ No (enter here:)

1/30/2025

Subsection
Risk
Adjustment
and
Stratification

Row
132

Field Label
Risk adjustment variable
types

Guidance
Select ALL risk adjustment variable types that are included
in your final risk model. For more information on how to
select risk factors for accountability measures, refer to the
Blueprint content on the CMS MMS Hub.
Select “Patient-level demographics” if the measure uses
information related to each patient’s age, sex, social,
economic, and geographic factors, etc.

ADD YOUR CONTENT HERE
☐ Patient community characteristics
☐ Patient functional status
☐ Patient-level demographics
☐ Patient-level health status & clinical conditions
☐ Patient-level social risk factors
☐ Proxy social risk factors
☐ Other (enter here):

Select “Patient-level health status & clinical conditions” if
the measure uses information specific to each individual
patient about their health status prior to the start of care
(e.g., case-mix adjustment).
Select “Patient functional status” if the measure uses
information specific to each individual patient’s functional
status prior to the start of care (e.g., body function, ability
to perform activities of daily living, etc.)
Select “Patient-level social risk factors” if the measure uses
patient-reported information related to their individual
social risks (e.g., income, living alone, etc.).
Select “Proxy social risk factors” if the measure uses data
related to characteristics of the people in the patient’s
community (e.g., neighborhood level income from the
census).
Select “Patient community characteristics” if the measure
uses information about the patient’s community (e.g.,
percent of vacant houses, crime rate).
Select “Other” if the risk factor is related to the healthcare
provider, health system, or other factor that is not related
to the patient.

2025 CMS MERIT DA TA TEMP LA TE

1/30/2025

Subsection
Risk
Adjustment
and
Stratification

Row
n/a

Risk
Adjustment
and
Stratification

133

Risk
Adjustment
and
Stratification

134

Risk
Adjustment
and
Stratification

135

Field Label
If you select “Patient-level
demographics” in Row 132,
then Row 133 becomes a
required field. If you select
“Patient-level health status
& clinical conditions” in
Row 132, then Row 134
becomes a required field. If
you select “Patient
functional status” in Row
132, then Row 135
becomes a required field. If
you select “Patient-level
social risk factors” in Row
132, then Row 136
becomes a required field. If
you select “Proxy social risk
factors” in Row 132, then
Row 137 becomes a
required field. If you select
“Patient community
characteristics” in Row 132,
then Row 138 becomes a
required field.

n/a

*Patient-level
demographics: please
select all that apply

Select all that apply

*Patient-level health status

Select all that apply

*Patient functional status:

Select all that apply

Guidance

☐ Age
☐ Social, Economic, and Geographic Factors
☐ Sex
☐ Other (enter here):
☐ Case-Mix Adjustment
☐ Comorbidities
☐ Health behaviors/health choices
☐ Severity of Illness
☐ Other (enter here):
☐ Ability to perform activities of daily living
☐ Body Function
☐ Other (enter here):

& clinical conditions: please
select all that apply

please select all that apply

2025 CMS MERIT DA TA TEMP LA TE

ADD YOUR CONTENT HERE
This is not a data entry field.

1/30/2025

Subsection
Risk
Adjustment
and
Stratification

Row
136

Risk
Adjustment
and
Stratification
Risk
Adjustment
and
Stratification

137

Risk
Adjustment
and
Stratification
Risk
Adjustment
and
Stratification

Field Label

Guidance

*Patient-level social risk
factors: please select all
that apply

Select all that apply

*Proxy social risk factors:

Select all that apply

*Patient community

Select all that apply

139

*Risk model performance

140

*Is the measure
recommended to be
stratified based on
evidence from testing
and/or literature?

Provide empirical evidence that the risk model adequately
accounts for confounding factors (e.g., assessment of
model calibration and discrimination). Describe your
interpretation of the results.
Select one. Indicate whether the final measure is
recommended to be stratified. Indicate whether the
recommended stratification is intended to address the
closing of care gaps.

please select all that apply
138

characteristics: please
select all that apply

Elements for stratification to address the closing of care
gaps includes sociodemographic data such as language, sex,
disability status, tribal sovereignty, and social, economic,
and geographic factors, as well as social determinants of
health (SDOH) featured in the Healthy People 2030 SDOH
Framework across five domains: economic stability,
education access and quality, health care access and
quality, neighborhood and built environment, and social
and community context.

ADD YOUR CONTENT HERE
☐ Education
☐ Income
☐ Living Alone
☐ Social Support
☐ Wealth
☐ Other (enter here):
☐ Dual Eligibility for Medicare and Medicaid
☐ Neighborhood Level Income from the Census
☐ Other (enter here):
☐ Crime Rate
☐ Percent of Vacant Houses
☐ Urban/Rural
☐ Other (enter here):
Free text field

☐ Yes, the measure is recommended to be stratified
to address a gap in care
☐ Yes, the measure is recommended to be stratified
for reasons unrelated to a gap in care
☐ Yes, the measure is recommended to be stratified
both to address a gap in care AND for other reasons
☐ No, the measure is not recommended to be
stratified

For more information about elements related to closing
care gaps, please refer to the Standardizing Data to Close
the Care Gap page on the CMS MMS Hub.

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Subsection
n/a

Row
n/a

Field Label
If you select a “Yes”
response in Row 140, then
Row 141 becomes a
required field. If you select
a “No” response in Row 140
AND selected a “No”
response in Row 129, then
Row 142 becomes a
required field. Otherwise
skip to Row 143.

Risk
Adjustment
and
Stratification

141

*Stratification approach

n/a

Guidance

Describe the recommended stratification approach
including the data elements used to stratify scores for
subgroups. Demonstrate that there is sufficient sample size
within measured entities to stratify measure scores.

ADD YOUR CONTENT HERE
This is not a data entry field.

Free text field

Indicate whether the recommendation to stratify the
measure is based on evidence from testing and/or the
literature.
If findings from testing informed the recommendation to
stratify the measure, summarize the findings indicating that
stratification would improve interpretation of measure
results. If more room is needed, provide testing results as
an attachment and list the name of the attachment in this
field.

Risk
Adjustment
and
Stratification

142

*Rationale for using
neither risk adjustment nor
stratification

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If evidence from the literature informed the
recommendation to stratify the measure, provide citations
supporting your stratification approach.
Select ALL reasons for not implementing a risk adjustment
model or stratification approach in the measure. For more
information, refer to the Risk Adjustment in Quality
Measurement supplemental material on the CMS MMS
Hub and the guidance on defining stratification schemes.

☐ Addressed through exclusions
☐ Data were not available to evaluate risk adjustment
or stratification (enter here):
☐ Risk adjustment and stratification were not
considered during development or testing
☐ Risk adjustment not appropriate based on
conceptual or empirical rationale (enter here):
☐ Other (enter here):

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Subsection
Healthcare
Domain

Row
143

Field Label

Healthcare
Domain

144

What, if any, additional
Meaningful Measures 2.0
domain apply to this
measure?

Select up to two additional Meaningful Measures 2.0
domain that apply to this measure.

Other Priorities

145

Select one.

Endorsement
Characteristics

146

*Does this measure
address CMS priorities to
improve maternal health
care or maternal
outcomes?

Endorsement
Characteristics

*What one Meaningful
Measures 2.0 domain is
most applicable to this
measure?

Guidance
Select the ONE most applicable Meaningful Measures 2.0
domain.

*What is the endorsement

Select only one. For information on consensus-based entity
(CBE) endorsement, measure ID, and other information,
refer to the PQM Webpage.

147

*CBE ID (CMS consensusbased entity, or
endorsement ID)

Endorsement
Characteristics

148

n/a

If endorsed: Is the measure
being submitted exactly as
endorsed by the CMS CBE?
If you select “No” in Row
148, then Rows 149-150
become required fields.

Four- or five-character identifier with leading zeros and
following letter if needed. Add a letter after the ID (e.g.,
0064e) and place zeros ahead of ID if necessary (e.g., 0064).
If no CBE ID number is known, enter numerals 9999.
Select 'Yes' or 'No'. Note that 'Yes' should only be selected
if the submission is an EXACT match to the CBE-endorsed
measure.
n/a

status of the measure?

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ADD YOUR CONTENT HERE
☐ Behavioral Health
☐ Chronic Conditions and Related Acute Events
☐ Closing Gaps of Care
☐ Person-Centered Care
☐ Safety
☐ Seamless Care Coordination
☐ Value, Affordability, and Efficiency
☐ Wellness and Prevention
☐ Behavioral Health
☐ Chronic Conditions and Related Acute Events
☐ Closing Gaps of Care
☐ Person-Centered Care
☐ Safety
☐ Seamless Care Coordination
☐ Value, Affordability, and Efficiency
☐ Wellness and Prevention
☐ Yes
☐ No

☐ Endorsed
☐ Endorsed with conditions
☐ Endorsement removed
☐ Submitted
☐ Failed endorsement or decision to not endorse
☐ Never submitted
ADD YOUR CONTENT HERE

☐ Yes
☐ No
This is not a data entry field.

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Subsection
Endorsement
Characteristics

Row
149

Field Label
If not exactly as endorsed,
specify the locations of the
differences

Guidance
Indicate which specification fields are different. Select all
that apply

Endorsement
Characteristics

150

Briefly describe the differences

Endorsement
Characteristics

151

If not exactly as endorsed,
describe the nature of the
differences
If endorsed: Year of most
recent CBE endorsement

Endorsement
Characteristics

152

Year of next anticipated
CBE endorsement review

Select one. If you are submitting for initial endorsement,
select the anticipated year.

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Select one

ADD YOUR CONTENT HERE
☐ Measure title
☐ Description
☐ Numerator
☐ Denominator
☐ Exclusions
☐ Target population
☐ Setting (for testing)
☐ Level of analysis
☐ Data source
☐ eCQM status
☐ Other (enter here and see next field):
Free text field
☐ 2017
☐ 2018
☐ 2019
☐ 2020
☐ 2021
☐ 2022
☐ 2023
☐ 2024
☐ 2025
☐ 2026
☐ 2027
☐ 2028
☐ 2029

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SIMILAR MEASURES
Subsection
Related and
Competing
Measures

Row
153

n/a

Related and
Competing
Measures

154

Related and
Competing
Measures

155

Related and
Competing
Measures

156

Related and
Competing
Measures

157

Field Label

*Is this measure related to

and/or competing with
measure(s) already in a
program?
If you select “Yes” in Row
153, then Rows 154-156
become required fields. If
you select “No” in Row
153, then skip to Row 157.

*Which measure(s)
already in a program is
your measure related to
and/or competing with?

*How will this measure
add value to the Medicare
program?

*How will this measure be
distinguished from other
related and/or competing
measures?
*Universal Foundation
Measure

Guidance
Select either Yes or No. Consider other measures with
related purposes.

☐ Yes
☐ No

ADD YOUR CONTENT HERE

n/a

This is not a data entry field.

Identify the other measure(s) including title and any
other unique identifier.

Free text field

Describe benefits of this measure, in comparison to
measure(s) already in a program.

Free text field

In your response, please also consider distribution of
measure impact, benefits, and burdens across program
entities and populations (Appropriateness of Scale) as
well as potential near and long term impacts of measure
implementation (Time to Value Realization).
Describe key differences that set this measure apart
from others.

Select one. Indicate whether this measure is a Universal
Foundation quality measure.
To be considered a Universal Foundation quality
measure, the submitted measure’s population must align
with the population of the existing Universal Foundation
measure (i.e., adult and/or pediatric).

Free text field

☐ Measure is a Universal Foundation quality measure
(populations must align)
☐ Measure is not a Universal Foundation quality
measure

Please refer to the “Aligning Quality Measures Across
CMS – the Universal Foundation” webpage for more
information about Universal Foundation of quality
measures.

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ATTACHMENTS
Subsection
N/A

Row
158

Field Label
Attachment(s)

Guidance
You are encouraged to attach the Measure Information
and Justification Form (MIJF) if available. The MIJF is a
guide for documenting specifications and measure
development information when submitting contracted
measure deliverables to CMS. Previously, the
recommended form included the Measure Information
Form (MIF), which was combined with the Measure
Justification Form (MJF) into a single form. For all future
measure submissions, CMS prefers the MIJF. However,
if a submitter already has a MIF from last year's
submission, that would be accepted. If a MIJF is not
available, comprehensive measure methodology
documents are encouraged.

ADD YOUR CONTENT HERE
☐ Alternative Level Testing Results
☐ eCQM Materials (Specifications, Test Cases, Value Sets,
Feasibility Scorecard)
☐ Measure Information and Justification Form (MIJF)
☐ Measure Information Form (MIF)
☐ MIPS Peer Reviewed Journal Article Template
☐ Risk Adjusted Materials
☐ Other (Please specify:)

If you are submitting for MIPS (either Quality or Cost),
you are required to download the MIPS Peer Reviewed
Journal Article Template and attach the completed form
to your submission using the “Attachments” feature.
If your measure is risk adjusted, you are encouraged to
attach documentation that provides additional detail
about the measure risk adjustment model such as
variables included, associated code system codes, and
risk adjustment model coefficients

N/A

159

MIPS Peer Reviewed
Journal Article Template

If eCQM, you must attach the eCQM specifications
exported from MADiE, test cases exported from MADiE
with 100% coverage/100% passing (both QRDA and
Excel format), attestation that value sets are published
in VSAC, and feasibility scorecard.
Select Yes or No. For those submitting quality measures
to MIPS program, enter “Yes.” Attach your completed
Peer Reviewed Journal Article Template.

☐ Yes
☐ No

SUBMITTER COMMENTS

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Subsection
N/A

Row
160

Field Label
Submitter Comments

Guidance
Any notes, qualifiers, external references, or other
information not specified above.

Free text field

ADD YOUR CONTENT HERE

Send any questions to MMSsupport@battelle.org

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Appendix: Lengthy Lists of Choices
A.001

Choices f or Measure Steward or Owner and Long-Term Measure Steward or Owner (if different)

Agency for Healthcare Research & Quality
Alliance of Dedicated Cancer Centers
Ambulatory Surgical Center (ASC) Quality Collaboration
American Academy of Allergy, Asthma & Immunology (AAAAI)
American Academy of Dermatology
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Otolaryngology – Head and Neck Surgery (AAOHN)
American College of Cardiology
American College of Cardiology/American Heart Association
American College of Emergency Physicians
American College of Emergency Physicians (previous steward Partners-Brigham &
Women's)
American College of Obstetricians and Gynecologists (ACOG)
American College of Radiology
American College of Rheumatology
American College of Surgeons
American Gastroenterological Association
American Health Care Association
American Medical Association
American Nurses Association
American Psychological Association
American Society for Gastrointestinal Endoscopy
American Society for Radiation Oncology
American Society of Addiction Medicine
American Society of Anesthesiologists
American Society of Clinical Oncology
American Society of Clinical Oncology
American Urogynecologic Society
American Urological Association (AUA)
Audiology Quality Consortium/American Speech-Language-Hearing Association
(AQC/ASHA)
Bridges to Excellence
Centers for Disease Control and Prevention
Centers for Medicare & Medicaid Services
Eugene Gastroenterology Consultants, PC Oregon Endoscopy Center, LLC
Health Resources and Services Administration (HRSA) - HIV/AIDS Bureau

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Heart Rhythm Society (HRS)
Indian Health Service
Infectious Diseases Society of America (IDSA)
Intersocietal Accreditation Commission (IAC)
KCQA- Kidney Care Quality Alliance
Minnesota (MN) Community Measurement
National Committee for Quality Assurance
National Minority Quality Forum
Office of the National Coordinator for Health Information Technology/Centers for
Medicare & Medicaid Services
Oregon Urology Institute
Oregon Urology Institute in collaboration with Large Urology Group Practice Association
Pharmacy Quality Alliance
Philip R. Lee Institute for Health Policy Studies
Primary (care) Practice Research Network (PPRNet)
RAND Corporation
Renal Physicians Association; joint copyright with American Medical Association Seattle Cancer Care Alliance
Society of Gynecologic Oncology
Society of Interventional Radiology
The Academy of Nutrition and Dietetics
The Joint Commission
The Society for Vascular Surgery
The University of Texas MD Anderson Cancer Center
University of Minnesota Rural Health Research Center
University of North Carolina- Chapel Hill
Wisconsin Collaborative for Healthcare Quality (WCHQ)
Other (enter in Row 084 and/or Row 086)

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A.108

Choices f or Areas of specialty

Addiction medicine
Allergy/immunology
Anesthesiology
Behavioral health
Cardiac electrophysiology
Cardiac surgery
Cardiovascular disease (cardiology)
Chiropractic medicine
Colorectal surgery (proctology)
Critical care medicine (intensivists)
Dermatology
Diagnostic radiology
Electrophysiology
Emergency medicine
Endocrinology
Family practice
Gastroenterology
General practice
General surgery
Geriatric medicine
Gynecological oncology
Hand surgery
Hematology/oncology

Hospice and palliative care
Infectious disease
Internal medicine
Interventional pain management
Interventional radiology
Maxillofacial surgery
Medical oncology
Nephrology
Neurology
Neuropsychiatry
Neurosurgery
Nuclear medicine
Nursing
Nursing homes
Obstetrics/gynecology
Ophthalmology
Optometry
Oral surgery (dentists only)
Orthopedic surgery
Osteopathic manipulative medicine
Otolaryngology
Pain management
Palliative care

Pathology
Pediatric medicine
Peripheral vascular disease
Physical medicine and rehabilitation
Plastic and reconstructive surgery
Podiatry
Preventive medicine
Primary care
Psychiatry
Public and/or population health
Pulmonary disease
Pulmonology
Radiation oncology
Rheumatology
Sleep medicine
Sports medicine
Surgical oncology
Thoracic surgery
Urology
Vascular surgery
Other (enter in Row 097)

Send any questions to MMSsupport@battelle.org

2025 CMS MERIT DA TA TEMP LA TE

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According to the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.), 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 0938-1314 (Expiration date:
2/28/2027). This information collection is the tool for measure developers to submit their clinical quality measures for consideration by CMS. The
time required to complete this information collection is estimated to average 3.5 hours per response, including the time to review instructions,
search existing data resources, gather the data needed, to review and complete the information collection. This information collection is
voluntary and all information collected will be kept private in accordance with regulations at 45 CFR 155.260, Privacy and Security of Personally
Identifiable Information. Pursuant to this regulation, CMS may only use or disclose personally identifiable information to the extent that such
information is necessary to carry out their statutory and regulatory mandated functions. 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, MD 21244-1850. If you have questions or concerns regarding where to submit your documents, please contact QPP at
qpp@cms.hhs.gov.
Under the Privacy Act of 1974 (5 U.S.C. 552a) any personally identifying information obtained will be kept private to the extent of the law.

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1/30/2025

File Type	application/pdf
File Title	Measures Under Consideration Entry/Review and Information Tool 2025 Data Template for Candidate Measures
Subject	MUC, 2025, Data Template, Candidate Measures
Keywords	MUC, 2025, Data Template, Candidate Measures
Author	Centers for Medicare & Medicaid Services (CMS)
File Modified	2025:08:20 14:47:22-04:00
File Created	2025:05:15 14:37:36-04:00