Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool ("PAT")

Forms and Documents

Document Name	Status
Form CMS-10136 Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - MCMP Demonstration Form and Instruction	Removed
Form CMS-10136 Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) -EHR Demonstration Form and Instruction	Removed
Form CMS-10136 Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - PGP Demonstration Form and Instruction	Modified
Supporting Statement - Part B - PGP TD_062112.docx Supporting Statement B	2012-06-22
2Supporting_Statement_-_Part_A_PGPTD.pdf Supporting Statement A	2012-05-18

IC Document Collections

IC ID	Document Title	Status
8793	Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - MCMP Demonstration Form and Instruction	Removed
186735	Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) -EHR Demonstration Form and Instruction	Removed
186734	Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - PGP Demonstration Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0941	ICR Reference No: 201205-0938-008
Status: Historical Active	Previous ICR Reference No: 200809-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool ("PAT")
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/16/2012
	Date Received in OIRA: 05/22/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2015	36 Months From Approved
Responses	10	0	0
Time Burden (Hours)	790	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Performance Assessment Tool ("PAT) is being used to collect clinical quality measure information. It is not an electronic health record but rather a tool for collecting 'numerator' and 'denominator' information that is used to calculate performance measures on specific clinical quality measures. The tool is currently approved for use in the Physician Group Practice Demonstration (PGP), a congressionally mandated demonstration that will continue data collection past the current expiration date and through September 2013.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 649 Name of Law: MCMP Demonstration - Medicare Prescription Drug Improvement and Modernization Act of 2003
   US Code: 42 USC 1395b-1 Name of Law: EHR Demonstration
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 13337	03/06/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 29645	05/18/2012
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - PGP Demonstration	CMS-10136, CMS-10136	PGP_TD-PAT_Screen_ShotsJH
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - MCMP Demonstration	CMS-10136	MCMP PAT
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) -EHR Demonstration	CMS-10136	MCMP PAT

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	10	0	0	10	0	0
Annual Time Burden (Hours)	790	0	0	790	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The burden increase is due to the reinstatement of the collection. However, none of the burden per task has changed since the original collection.

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Annual Cost to Federal Government: $906,202

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/22/2012

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