[Federal Register Volume 83, Number 182 (Wednesday, September 19, 2018)]
[Notices]
[Pages 47343-47345]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-20372]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10673]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare & Medicaid Services, Department of Health 
and Human Services.

ACTION: Notice.

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SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is 
announcing an opportunity for the public to comment on CMS' intention 
to collect information from the public. Under the Paperwork Reduction 
Act of 1995 (PRA), federal agencies are required to publish notice in 
the Federal Register concerning each proposed collection of 
information, including each proposed extension or reinstatement of an 
existing collection of information, and to allow a second opportunity 
for public comment on the notice. Interested persons are invited to 
send comments regarding the burden estimate or any other aspect of this 
collection of information, including the necessity and utility of the 
proposed information collection for the proper performance of the 
agency's functions, the accuracy of the estimated burden, ways to 
enhance the quality, utility, and clarity of the information to be 
collected, and the use of automated collection techniques or other 
forms of information technology to minimize the information collection 
burden.

DATES: Comments on the collection(s) of information must be received by 
the OMB desk officer by October 19, 2018.

ADDRESSES: When commenting on the proposed information collections, 
please reference the document identifier or OMB control number. To be 
assured consideration, comments and recommendations must be received by 
the OMB desk officer via one of the following transmissions: OMB, 
Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-5806 or Email: 
[email protected].
    To obtain copies of a supporting statement and any related forms 
for the proposed collection(s) summarized in this notice, you may make 
your request using one of following:
    1. Access CMS' website address at http://www.cms.hhs.gov/PaperworkReductionActof1995.
    2. Email your request, including your address, phone number, OMB 
number, and CMS document identifier, to [email protected].
    3. Call the Reports Clearance Office at (410) 786-1326.

FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786-4669.

SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995 
(PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from 
the Office of Management and Budget (OMB) for each collection of 
information they conduct or sponsor. The term ``collection of 
information'' is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and 
includes agency requests or requirements that members of the public 
submit reports, keep records, or provide information to a third party. 
Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires 
federal agencies to publish a 30-day notice in the Federal Register 
concerning each proposed collection of information, including each 
proposed extension or reinstatement of an existing collection of 
information, before submitting the collection to OMB for approval. To 
comply with this requirement, CMS is publishing this notice that 
summarizes the following proposed collection(s) of information for 
public comment:
    1. Type of Information Collection Request: New Collection (Request 
for a new OMB control number); Title of Information Collection: 
Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) 
Demonstration; Use: The Centers for Medicare & Medicaid Services (CMS) 
may test a demonstration, under Section 402 of the Social Security 
Amendments of 1968 (as amended), entitled the Medicare Advantage 
Qualifying Payment Arrangement Incentive (MAQI) Demonstration (``the 
Demonstration''). If it goes forward, the MAQI demonstration could test 
whether exempting, through the use of waiver authority, clinicians who 
participate to a sufficient degree in certain payment arrangements with 
Medicare Advantage Organizations (MAOs) (combined with participation, 
if any, in Advanced Alternative Payment Models (APMs) with Medicare 
Fee-for-Service (FFS)) from the Merit-based Incentive Payment System 
(MIPS) reporting requirements

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and payment adjustment will increase or maintain participation in 
payment arrangements with MAOs similar to Advanced APMs and change the 
manner in which clinicians deliver care.
    Clinicians may currently participate in one of two paths of the 
Quality Payment Program (QPP): (1) MIPS, which adjusts Medicare 
payments based on combined performance on measures of quality, cost, 
improvement activities, and advancing care information, or (2) Advanced 
Alternative Payment Models with Medicare (Advanced APMs), under which 
eligible clinicians may earn an incentive payment for sufficient 
participation in certain payment arrangements with Medicare fee-for-
service (FFS) and other payers, and starting in the 2019 performance 
period, with other payers such as Medicare Advantage, commercial 
payers, and Medicaid managed care. To participate in the Advanced APM 
path of QPP for a given year, eligible clinicians must meet the 
criteria of Qualifying APM Participants (QPs); in addition to earning 
an APM incentive payment, QPs are excluded from the MIPS reporting 
requirements and payment adjustment.
    An eligible clinician that does not meet the criteria to be a QP 
for a given year will be subject to MIPS for that year unless the 
clinician meets certain other MIPS exclusion criteria, such as being 
newly enrolled in Medicare or meeting the low volume threshold for 
Medicare FFS patients. The MAQI Demonstration could allow participating 
clinicians to have the opportunity to be exempt from MIPS reporting and 
payment consequences for a given year if they participate to a 
sufficient degree in certain Qualifying Payment Arrangements with MAOs 
(and Advanced APMs with Medicare FFS) during the performance period for 
that year, without requiring them to be QPs or otherwise meet the MIPS 
exclusion criteria of QPP. Under a possible Demonstration, clinicians 
might not be required to have a minimum amount of participation in an 
Advanced APM with Medicare FFS in order to be exempt from MIPS 
reporting requirements and payment adjustments for a year, but if they 
did have participation in Advanced APMs with Medicare FFS, that 
participation could also be counted towards the thresholds that trigger 
the waiver from MIPS reporting and payment consequences. In addition, 
the Demonstration could permit consideration of participation in 
``Qualifying Payment Arrangements'' with Medicare Advantage plans that 
meet the criteria to be Other Payer Advanced APMs a year before the 
All-Payer Combination Option is available.
    In the Calendar Year 2018 Quality Payment Program Final Rule, CMS 
noted its intention ``to develop a demonstration project to test the 
effects of expanding incentives for eligible clinicians to participate 
in innovative alternative payment arrangements under Medicare Advantage 
that qualify as Advanced APMs, by allowing credit for participation in 
such Medicare Advantage arrangements prior to 2019 and incentivizing 
participation in such arrangements in 2018 through 2024.'' (92 FR 
53865).
    The first performance period for the Demonstration is tentatively 
planned for 2018 and the Demonstration would last up to five years. 
Clinicians who meet the definition of MIPS eligible clinician under QPP 
as defined under 42 CFR 414.1305 would be eligible to participate in 
the MAQI Demonstration. Currently, MIPS eligible clinicians include 
physicians (including doctors of medicine, doctors of osteopathy, 
osteopathic practitioners, doctors of dental surgery, doctors of dental 
medicine, doctors of podiatric medicine, doctors of optometry, and 
chiropractors), physician assistants, nurse practitioners, clinical 
nurse specialists, and certified registered nurse anesthetists. If the 
definition of MIPS eligible clinician changes under future rulemaking, 
the Demonstration would use the updated definition to define 
Demonstration eligibility.
    Participation could last the duration of the Demonstration, unless 
participation is voluntarily or involuntarily terminated under the 
terms and conditions of the Demonstration. Participants would have the 
opportunity to submit the required documentation and be evaluated for 
MIPS waivers through the Demonstration each year.
    Should this demonstration move forward, and in order to conduct an 
evaluation and effectively implement the MAQI Demonstration, CMS would 
need to collect information from Demonstration participants on (a) 
payment arrangements with MAOs and (b) Medicare Advantage (MA) payments 
and patient counts. CMS would require a new collection of this 
information as this information is not already available through other 
sources and/or has not been previously approved for use under the MAQI 
Demonstration. The information collected in these forms would allow CMS 
to evaluate whether the payment arrangement that clinicians have with 
MAOs meet the Qualifying Payment Arrangement criteria, and determine 
whether a clinician's MAO and FFS APM patient population or payments 
meet demonstration thresholds. Both of these areas are also 
requirements for review and data collection under QPP (i.e. the 
Eligible Clinician-Initiated Other Payer Advanced APM Determination 
form and All-Payer QP Submission form), and therefore similar to forms 
have been prepared and reviewed under the QPP.
    Given these similarities in forms, burden estimates for the MAQI 
Demonstration PRA package were derived from burden analyses and 
formulation done in conjunction with the QPP forms; more specifically 
the estimated burden associated with the submission of payment 
arrangement information for Other Payer Advanced APM Determinations: 
Eligible Clinician-Initiated Process, and the estimated burden 
associated with the submission of data for All-Payer QP determinations. 
CMS estimates the total hour burden per respondent for the MAQI 
demonstration to be 15 hours, to match the hours listed in the 
equivalent QPP forms. Full detail of how these estimates were derived 
can be found in the forthcoming Calendar Year 2019 Proposed QPP rule.
    If Demonstration participants submitted information, but did not 
meet these conditions of the Demonstration, their participation in the 
Demonstration would not be terminated, but they would not receive the 
waivers from MIPS reporting requirements and payment adjustments. 
Therefore, unless they become QPs or are excluded from MIPS for other 
reasons, the participating clinicians would be subject to MIPS and 
would face the MIPS payment adjustments for the applicable year. We are 
requesting approval of 2 information collections associated with the 
MAQI Demonstration: (a) A Qualifying Payment Arrangement Submission 
Form and (b) a Threshold Data Submission Form. Subsequent to publishing 
the 60-day Federal Register notice (83 FR 31150), there have been minor 
revisions made to the collection instrument to clarify information. 
There is no increase in the burden hours. Form Number: CMS-10673 (OMB 
control number: 0938-NEW); Frequency: Annually; Affected Public: 
Private sector--Business or other for-profit and Not-for-profit 
institutions; Number of Respondents: 100,000; Total Annual Responses: 
100,000; Total Annual Hours: 1,500,000. (For policy questions regarding 
this collection contact John Amoh at [email protected].)


[[Page 47345]]


    Dated: September 14, 2018.
Martique Jones,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 2018-20372 Filed 9-18-18; 8:45 am]
 BILLING CODE 4120-01-P