Qis Implementation Plan And Progress Report Form Page 13

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QIS Implementation Plan and Progress Report Form
OMB 0938-1286
Expiration Date: 10/31/2018
24e. Provide numerical value performance target for this measure:
24a. Measure 1b
Is Measure 1b modified from the most recent QIS submission?
Yes
No
Not Applicable
Measure 1b Name:
Provide a narrative description of the measure numerator and denominator.
(500 character limit)
Is this a National Quality Forum (NQF)-endorsed measure?
Yes
No
If yes, provide the 4-digit ID number:
If yes, did the issuer modify the NQF-endorsed measure specification?
Yes
No
24b. Describe how [Measure 1b] supports the tracking of performance related to [Goal 1].
(1,000 character limit)
pg. 13
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid
Office of Management and Budget (OMB) control number. The valid OMB control number for this information collection is 0938-1286. The time
required to complete this information collection is estimated to average 48 hours. 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, Maryland 21244-1850.

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