PRA Listing

Information collections available for public comment.

CMS Form Number	Date	Subject
CMS Form Number CMS-10902	Date 2024-11-22	Subject Environmental Health Hazards Checklist Medicare Coverage for Individuals Exposed to Environmental Health Hazards
CMS Form Number CMS-10796	Date 2024-11-22	Subject Dual Eligible Special Needs Plan Contract with the State Medicaid Agency
CMS Form Number CMS-10398 #85	Date 2024-11-18	Subject 3.1-M State Plan Amendment (SPA) Templates for Eligible Juveniles Who are Inmates of a Public Institution
CMS Form Number CMS-10237	Date 2024-11-08	Subject Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits
CMS Form Number CMS-10631	Date 2024-11-08	Subject The PACE Organization Application Process in 42 CFR Part 460
CMS Form Number CMS-10829	Date 2024-11-06	Subject Improper Payment Pre-Testing and Assessment (IPPTA) Data Request Form
CMS Form Number CMS-R-308	Date 2024-11-06	Subject State Children's Health Insurance Program and Supporting Regulations
CMS Form Number CMS-R-262	Date 2024-11-06	Subject CMS Plan Benefit Package (PBP) and Formulary CY 2026 (CMS-R-262)
CMS Form Number CMS-10398 #88	Date 2024-11-05	Subject Medicaid/CHIP School-Based Services (SBS) Grants
CMS Form Number CMS-10520	Date 2024-11-01	Subject Marketplace Quality Standards
CMS Form Number CMS-10398 #86	Date 2024-11-01	Subject Section 1115 Reentry Demonstration Initiative
CMS Form Number CMS-379	Date 2024-10-31	Subject Financial Statement of Debtor
CMS Form Number CMS-10137	Date 2024-10-31	Subject Solicitation for Applications for Medicare prescription Drug Plan 2026 Contracts
CMS Form Number CMS-40B	Date 2024-10-30	Subject Application for Enrollment in Medicare the Medical Insurance Program
CMS Form Number CMS-10341	Date 2024-10-30	Subject Section 1115 Demonstration Projects Regulations
CMS Form Number CMS-4040	Date 2024-10-30	Subject Request for Enrollment in Supplementary Medical Insurance
CMS Form Number CMS-10875	Date 2024-10-30	Subject Reporting Requirements and Corrective Action Plans Under Section 1902(tt) of the Social Security Act
CMS Form Number CMS-10261	Date 2024-10-28	Subject Part C Medicare Advantage Reporting
CMS Form Number CMS-10912	Date 2024-10-28	Subject Medicare Transaction Facilitator for 2026 and 2027 under Sections 11001 and 11002 of the Inflation Reduction Act (IRA)
CMS Form Number CMS-10114	Date 2024-10-21	Subject National Provider Identifier (NPI) Application and Update Form and Supporting Regs in 45 CFR 142.408, 45 CFR 162.408, 45 CFR 162.406
CMS Form Number CMS-10171	Date 2024-10-21	Subject Part D Coordination of Benefits Data
CMS Form Number CMS-10147	Date 2024-10-21	Subject Medicare Drug Coverage and Your Rights
CMS Form Number CMS-855B	Date 2024-10-15	Subject Medicare Enrollment Application – Clinics/Group Practices and Other Suppliers
CMS Form Number CMS-10868	Date 2024-10-15	Subject Medicare Change of Status Notice (MCSN)
CMS Form Number CMS-10885	Date 2024-10-15	Subject Retrospective Appeal Requests
CMS Form Number CMS-10840	Date 2024-10-10	Subject Supporting Statement for Agent/Broker Consent Information Collection
CMS Form Number CMS-10142	Date 2024-10-09	Subject Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)
CMS Form Number CMS-10203	Date 2024-10-09	Subject Medicare Health Outcomes Survey
CMS Form Number CMS-10157	Date 2024-10-02	Subject The HIPAA Eligibility Transaction System (HETS)
CMS Form Number CMS-10844	Date 2024-10-02	Subject Small Biotech Exception and Biosimilar Delay
CMS Form Number CMS-10539	Date 2024-10-01	Subject Medicare and Medicaid Programs: Home Health Facilities (HHAs) and Supporting Regulations
CMS Form Number CMS-224-14	Date 2024-09-30	Subject Federally Qualified Health Center Cost Report Form
CMS Form Number CMS-10856	Date 2024-09-26	Subject Medicaid Managed Care and Supporting Regulations
CMS Form Number CMS-2744	Date 2024-09-26	Subject End Stage Renal Disease (ESRD) Annual Facility Survey Form
CMS Form Number CMS-10516	Date 2024-09-24	Subject Program Integrity: Exchange, Premium Stabilization Programs, and Market Standards
CMS Form Number CMS-10156	Date 2024-09-23	Subject Retiree Drug Subsidy (RDS) Application and Instructions
CMS Form Number CMS-10170	Date 2024-09-23	Subject Retiree Drug Subsidy Payment Request and Instructions
CMS Form Number CMS-372(S)	Date 2024-09-19	Subject Annual Report on Section 1915(c) Home and Community-Based Services Waivers and Supporting Regulations
CMS Form Number CMS-R-284	Date 2024-09-19	Subject Transformed – Medicaid Statistical Information System (T-MSIS)
CMS Form Number CMS-216-94	Date 2024-09-19	Subject Organ Procurement Organization/Histocompatibility Laboratory Cost Report
CMS Form Number CMS-R-297	Date 2024-09-17	Subject Medicare Request for Employment Information
CMS Form Number CMS-2088-17	Date 2024-09-17	Subject The Community Mental Health Center Cost Report
CMS Form Number CMS-10003	Date 2024-09-17	Subject Notice of Denial of Medical Coverage (or Payment) (NDMCP)
CMS Form Number CMS-10146	Date 2024-09-17	Subject Notice of Denial of Medicare Prescription Drug Coverage
CMS Form Number CMS-10326	Date 2024-09-11	Subject Electronic Submission of Medicare Graduate Medical Education (GME) Affiliation Agreements
CMS Form Number CMS-10913	Date 2024-09-10	Subject Medicare Part C Utilization Management Annual Data Submission and Audit Protocol Data Request
CMS Form Number CMS-10443	Date 2024-09-10	Subject The TVT Registry
CMS Form Number CMS-R-290	Date 2024-09-10	Subject Medicare Program Procedures for Making National Coverage Determinations
CMS Form Number CMS-10141	Date 2024-09-10	Subject Medicare Prescription Drug Benefit Program
CMS Form Number CMS-R-234	Date 2024-09-09	Subject Subpart D-Private Contracts and Supporting Regulations in 42 CFR 405.410, 405.430, 405.435, 405.440, 405.445, 405.455
CMS Form Number CMS-10430	Date 2024-09-09	Subject Information Collection Requirements for Compliance with Individual and Group Market Reforms under Title XXVII of the Public Health Service Act
CMS Form Number CMS-1984-14	Date 2024-09-09	Subject Hospice Facility Cost Report
CMS Form Number CMS-10773	Date 2024-09-09	Subject Nonquantitative Treatment Limitation Analyses and Compliance Under MHPAEA
CMS Form Number CMS-10280	Date 2024-09-05	Subject Home Health Change of Care Notice
CMS Form Number CMS-R-153	Date 2024-09-03	Subject Medicaid Drug Use Review (DUR) Program
CMS Form Number CMS-10536	Date 2024-09-03	Subject Medicaid Eligibility and Enrollment (EE) Implementation Advanced Planning Document (IAPD) Template
CMS Form Number CMS-179	Date 2024-09-03	Subject Medicaid State Plan Base Plan Pages
CMS Form Number CMS-10650	Date 2024-08-30	Subject State Permissions for Enrollment in Qualified Health Plans in the Federally Facilitated Exchange & Non-Exchange Entities (CMS-10650)
CMS Form Number CMS-18F5	Date 2024-08-29	Subject Application for Enrollment in Medicare Part A Internet Claim (iClaim) Application Screen Modernized Claims System and Consolidated Claim Experience Screens
CMS Form Number CMS-287-22	Date 2024-08-29	Subject Home Office Cost Statement
CMS Form Number CMS-10897	Date 2024-08-28	Subject Supplemental to Form CMS-2552-10 Payment Adjustment for Establishing and Maintaining Access to Buffer Stock of Essential Medicines
CMS Form Number CMS-R-240	Date 2024-08-24	Subject Prospective Payments for Hospital Outpatient Services and Supporting Regulations in 42 CFR 413.65
CMS Form Number CMS-10653	Date 2024-08-22	Subject Coverage of Certain Preventive Services Under the Affordable Care Act (CMS-10653)
CMS Form Number CMS-R-263	Date 2024-08-21	Subject On-Site Inspection for Durable Medical Equipment (DME) Supplier Location and Supporting Regulations in 42 CFR, Section 424.57
CMS Form Number CMS-10884	Date 2024-08-13	Subject Prior Authorization Demonstration for Certain Ambulatory Surgical Center (ASC) Services
CMS Form Number CMS-10239	Date 2024-08-13	Subject Critical Access Hospital (CAH) Conditions of Participation (CoPs) and Supporting Regulations
CMS Form Number CMS-222-17	Date 2024-08-10	Subject Rural Health Clinic Cost Report
CMS Form Number CMS-10905	Date 2024-08-09	Subject Service Level Data Collection for Initial Determinations and Appeals
CMS Form Number CMS-R-285	Date 2024-08-07	Subject Medicare Request for Retirement Benefit Information
CMS Form Number CMS-10874	Date 2024-08-07	Subject Part D Drug Management Program
CMS Form Number CMS-10831	Date 2024-08-06	Subject Transitional Coverage and Retroactive Medicare Part D Coverage for Certain Low-Income Beneficiaries through the Limited Income Newly Eligible Transition (LI NET) Program
CMS Form Number CMS-10621	Date 2024-07-31	Subject Quality Payment Program (QPP)/Merit-Based Incentive Payment System (MIPS)
CMS Form Number CMS-10434 #82	Date 2024-07-30	Subject Quality Improvement Affinity Group Expression of Interest Form
CMS Form Number CMS-10437	Date 2024-07-30	Subject Generic Social Marketing & Consumer Testing Research
CMS Form Number CMS-10434 #66(BN)	Date 2024-07-24	Subject Medicaid and Children’s Health Insurance Program Renewal Compliance Template
CMS Form Number CMS-10530	Date 2024-07-22	Subject Ambulatory Surgical Center Quality Reporting Program
CMS Form Number CMS-10250	Date 2024-07-22	Subject Hospital Outpatient Quality Reporting (OQR) Program
CMS Form Number CMS-10870	Date 2024-07-22	Subject Rural Emergency Hospital Quality Reporting (REHQR)
CMS Form Number CMS-10434 #66	Date 2024-07-19	Subject Medicaid and Children’s Health Insurance Program Eligibility Processing Data Report
CMS Form Number CMS-10054	Date 2024-07-16	Subject New Technology Services for Ambulatory Payment Classifications under the Outpatient Prospective Payment System
CMS Form Number CMS-P-0015A	Date 2024-07-16	Subject Medicare Current Beneficiary Survey (MCBS)
CMS Form Number CMS-10316	Date 2024-07-16	Subject Implementation of the Medicare Prescription Drug Plan (PDP) and Medicare Advantage (MA) Plan Disenrollment Reasons Survey
CMS Form Number CMS-10440	Date 2024-07-15	Subject Data Collection to Support Eligibility Determinations for Insurance Affordability Programs and Enrollment through Health Benefits Exchanges, Medicaid and CHIP Agencies
CMS Form Number CMS-43	Date 2024-07-09	Subject Application for Part A (Hospital Insurance) and Part B (Medical Insurance) for People with End-Stage Renal Disease
CMS Form Number CMS-1500 and 1490S	Date 2024-07-09	Subject Health Insurance Common Claims Form and Supporting Regulations at 42 CFR Part 424, Subpart C
CMS Form Number CMS-10537	Date 2024-07-09	Subject CAHPS Hospice Survey
CMS Form Number CMS-855A	Date 2024-07-03	Subject Medicare Enrollment Application for Institutional Providers
CMS Form Number CMS-10516	Date 2024-07-02	Subject Program Integrity: Exchange, Premium Stabilization Programs, and Market Standards; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014; Final Rule II
CMS Form Number CMS-10849	Date 2024-07-02	Subject Negotiation Data Elements and Drug Price Negotiation Process for Initial Price Applicability Year 2027 under Sections 11001 and 11002
CMS Form Number CMS-R-246	Date 2024-06-25	Subject Medicare Advantage, Medicare Part D, and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey
CMS Form Number CMS-1696	Date 2024-06-25	Subject Appointment of Representative and Supporting Regulations in 42 CFR
CMS Form Number CMS-10332	Date 2024-06-14	Subject Disclosure Requirement for the In-Office Ancillary Services Exception
CMS Form Number CMS-10400	Date 2024-06-14	Subject Establishment of Qualified Health Plans and American Health Benefit Exchanges
CMS Form Number CMS-10636	Date 2024-06-10	Subject Triennial Network Adequacy Review for Medicare Advantage Organizations and 1876 Cost Plans
CMS Form Number CMS-10774	Date 2024-06-10	Subject The International Classification of Diseases, 10th Revision, Procedure Coding System (ICD–10–PCS)
CMS Form Number CMS-10379	Date 2024-06-04	Subject Rate Increase Disclosure and Review Requirements
CMS Form Number CMS-10858	Date 2024-06-03	Subject Rebate Reduction Requests under Sections 11101 and 11102 of the Inflation Reduction Act
CMS Form Number CMS-10454	Date 2024-06-03	Subject Disclosure of State Rating Requirements
CMS Form Number CMS-2540-24	Date 2024-05-29	Subject Skilled Nursing Facility and Skilled Nursing Facility Complex Cost Report
CMS Form Number CMS-10882	Date 2024-05-28	Subject The Medicare Advantage and Prescription Drug Programs: Part C and Part D Medicare Prescription Payment Plan Model Documents
CMS Form Number CMS-10185	Date 2024-05-24	Subject Medicare Part D Reporting Requirements
CMS Form Number CMS-10008	Date 2024-05-24	Subject Transitional Pass through payments related to Drugs, Biologicals, and Radiopharmaceuticals to determine eligibility under the Outpatient Prospective Payment System
CMS Form Number CMS-10526	Date 2024-05-23	Subject Cost-sharing Reduction Reconciliation
CMS Form Number CMS-10391	Date 2024-05-21	Subject Methods for Assuring Access to Covered Medicaid Services Under 42 CFR 447.203 and 447.204
CMS Form Number CMS-10695	Date 2024-05-21	Subject Quality Payment Program/Merit-Based Incentive Payment System (MIPS) Surveys and Feedback Collections
CMS Form Number CMS-10110	Date 2024-05-14	Subject Manufacturer Submission of Average Sales Price (ASP) Data for Medicare Part B Drugs and Biologicals
CMS Form Number CMS-10767	Date 2024-05-10	Subject Patient Access through Application Programming Interfaces (API)
CMS Form Number CMS-10164 A&B	Date 2024-05-10	Subject Medicare EDI Enrollment Form and EDI Registration
CMS Form Number CMS-319	Date 2024-05-06	Subject State Medicaid Eligibility Quality Control Sample Selection Lists and Supporting Regulations
CMS Form Number CMS-10166	Date 2024-05-02	Subject Fee-for-Service Improper Payment Rate Measurement in Medicaid and the Children’s Health Insurance Program
CMS Form Number CMS-10178	Date 2024-05-02	Subject Medicaid and Children’s Health Insurance (CHIP) Managed Care Payments and Related Information
CMS Form Number cms-10184	Date 2024-05-02	Subject Payment Error Rate Measurement – State Medicaid and CHIP Eligibility
CMS Form Number CMS-10102	Date 2024-05-02	Subject National Implementation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey
CMS Form Number CMS-10431	Date 2024-05-02	Subject Submission of Information for the PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program: FY 2025 IPPS/LTCH PPS Proposed Rule
CMS Form Number CMS-10668	Date 2024-05-02	Subject Submission of Information for the Hospital-Acquired Condition (HAC) Reduction Program
CMS Form Number CMS-10790	Date 2024-05-02	Subject Distribution of GME Residency Positions Under Section 126 of the Consolidated Appropriations Act (CAA), 2021, and Section 4122 of the CAA, 2023
CMS Form Number CMS-10788	Date 2024-04-30	Subject Prescription Drug and Health Care Spending
CMS Form Number CMS-R-148	Date 2024-04-25	Subject Limitations on Provider Related Donations and Health Care Related Taxes, Medicaid and Supporting Regulations in 42 CFR 433.68 through 433.74
CMS Form Number CMS-10722	Date 2024-04-25	Subject Annual State Report on CMS Value Based Purchasing Arrangements (VBP) Supplemental Rebate Agreements
CMS Form Number CMS-10291	Date 2024-04-25	Subject State Collection and Reporting of Dental Provider and Benefit Package Information on the Insure Kids Now! Web site and Hotline
CMS Form Number CMS-10529	Date 2024-04-25	Subject Quarterly Medicaid and CHIP Budget and Expenditure Reporting for the Medical Assistance Program, Administration and CHIP
CMS Form Number CMS-10891	Date 2024-04-18	Subject Medicaid Program; Medicare Savings Program Application and Eligibility Determinations
CMS Form Number CMS-10573	Date 2024-04-16	Subject Reform of Requirements for Long-Term Care Facilities
CMS Form Number CMS-10877	Date 2024-04-15	Subject Supporting Statement for Direct Enrollment Entities
CMS Form Number CMS-10803	Date 2024-04-15	Subject Essential Community Provider-Network Adequacy (ECP/NA) Data Collection to Support QHP Certification
CMS Form Number CMS-10878	Date 2024-04-15	Subject Information Collection Requirements for Non-Standardized Plan Option Limit Exceptions
CMS Form Number CMS-10887	Date 2024-04-08	Subject The Medicare Advantage and Prescription Drug Programs: Part C and Part D Medicare Advantage Prescription Drug (MARx) system
CMS Form Number CMS-10215	Date 2024-04-08	Subject Identifying Medicaid Payment for Physician Administered Drugs
CMS Form Number CMS-10394	Date 2024-04-08	Subject Application To Be a Qualified Entity to Receive Medicare Data for Performance Measurement / Reapplication / Annual Report Worksheet
CMS Form Number CMS-368 and R-144	Date 2024-04-08	Subject State Agency Contact Form (CMS-368) and Quarterly State Invoice (CMS-R-144)
CMS Form Number CMS-10549	Date 2024-04-08	Subject Generic Clearance: Questionnaire Testing and Methodological Research for the Medicare Current Beneficiary Survey (MCBS)
CMS Form Number CMS-10545	Date 2024-04-05	Subject Outcome and Assessment Information Set OASIS-E1
CMS Form Number CMS-10432	Date 2024-04-03	Subject Inpatient Psychiatric Facility Quality Reporting Program
CMS Form Number CMS-10390	Date 2024-03-28	Subject Hospice Outcomes and Patient Evaluation (HOPE) for the Collection of Data Pertaining to the Hospice Quality Reporting Program
CMS Form Number CMS-R-38	Date 2024-03-28	Subject Conditions for Certification for Rural Health Clinics and Conditions for Coverage for FQHCs in 42 CFR 4
CMS Form Number CMS-10558	Date 2024-03-27	Subject Machine Readable Data for Provider Network and Prescription Formulary Content for FFM QHPs
CMS Form Number CMS-10752	Date 2024-03-25	Subject Submissions of 1135 Waiver Request Automated Process
CMS Form Number CMS-10396	Date 2024-03-18	Subject Medication Therapy Management Program – Standardized Format
CMS Form Number CMS-10340	Date 2024-03-18	Subject Collection of Encounter Data from MA Organizations, Section 1876 Cost HMOs/CMPs, MMPs, and PACE Organizations
CMS Form Number CMS-8003	Date 2024-03-18	Subject 1915(c) Home and Community Based Services (HCBS) Waiver Application
CMS Form Number CMS-10398 #81	Date 2024-03-18	Subject Improving Quality of Care and Outcomes Data for Pregnant Medicaid Beneficiaries and Newborn Infants through Linkage and Evaluation of Vital Records (VR) Birth Certificates (BC), Death Certificates (DC) and T-MSIS Analytic Files (TAF)
CMS Form Number CMS-10279	Date 2024-03-13	Subject Medicare and Medicaid Programs: Conditions for Coverage for Ambulatory Surgical Centers
CMS Form Number CMS-304 and 304a	Date 2024-03-05	Subject Reconciliation of State Invoice (ROSI) (CMS-304) and Prior Quarter Adjustment Statement (PQAS) (CMS-304a)
CMS Form Number CMS-R-64	Date 2024-03-01	Subject Indirect Medical Education and Direct Graduate Medical Education
CMS Form Number CMS-10174	Date 2024-03-01	Subject Collection of Prescription Drug Data from MA-PD, PDP and Fallout Plans/Sponsors for Medicare Part D Payments
CMS Form Number CMS-10706	Date 2024-02-29	Subject Generic Clearance for the Center for Clinical Standards and Quality IT Product and Support Teams
CMS Form Number CMS-10500	Date 2024-02-26	Subject National Implementation of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey
CMS Form Number CMS-10249	Date 2024-02-21	Subject Administrative Requirements for Section 6071 of the Deficit Reduction Act
CMS Form Number CMS-10219	Date 2024-02-20	Subject HEDIS® Data Collection for Medicare Advantage
CMS Form Number CMS-10662	Date 2024-02-20	Subject Administrative Simplification HIPAA Compliance Review
CMS Form Number CMS-10843	Date 2024-02-08	Subject Advancing Interoperability and Improving Prior Authorization Processes
CMS Form Number CMS-10346	Date 2024-01-18	Subject Quality Bonus Payment Appeals
CMS Form Number CMS-10540	Date 2024-01-16	Subject Quality Improvement Strategy Implementation Plan, Progress Report, and Modification Summary Supplement Forms
CMS Form Number CMS-10718	Date 2024-01-11	Subject Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request
CMS Form Number CMS-10398 #45	Date 2024-01-09	Subject Certified Community Behavioral Health Clinic (CCBHC) 2024 State Proposal Demonstration Application
CMS Form Number CMS-10398 #48	Date 2024-01-09	Subject Behavioral Health Clinic Quality Data Reporting
CMS Form Number CMS-10398 #43	Date 2024-01-09	Subject Certified Community Behavioral Health Clinic (CCBHC) Cost Report
CMS Form Number CMS-10883	Date 2023-12-22	Subject ADA Dental Form
CMS Form Number CMS-10453	Date 2023-12-08	Subject Medicare Advantage and Prescription Drug Programs: Part C and Part D Explanation of Benefits
CMS Form Number CMS-10387	Date 2023-12-08	Subject Minimum Data Set 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) for the Collection of Data Related to the Patient Driven Payment Model and the Skilled Nursing Facility Quality Reporting Program (QRP)
CMS Form Number CMS-10525	Date 2023-12-01	Subject Programs of All-Inclusive Care for the Elderly (PACE) PACE Quality Data Monitoring and Reporting
CMS Form Number CMS-102 & 105	Date 2023-11-28	Subject CLIA Budget Workload Reports
CMS Form Number CMS-10866	Date 2023-11-24	Subject CMS Health Equity Award – Call for Nominations
CMS Form Number CMS-10418	Date 2023-11-22	Subject Annual MLR and Rebate Calculation Report and MLR Rebate Notices
CMS Form Number CMS-10398 #37	Date 2023-11-20	Subject Managed Care Rate Setting Guidance
CMS Form Number CMS-10510	Date 2023-11-16	Subject Basic Health Program Supporting Regulations
CMS Form Number CMS-10552	Date 2023-11-14	Subject Implementation of Medicare Programs; - Medicare Promoting Interoperability Program
CMS Form Number CMS-10652	Date 2023-10-31	Subject Virtual Groups for Merit-Based Incentive Payment System (MIPS)
CMS Form Number CMS-10434 #77	Date 2023-10-30	Subject Medicaid and Continuous Eligibility for Children
CMS Form Number CMS-10861	Date 2023-10-27	Subject Medicare Health Outcomes Survey Field Test
CMS Form Number CMS-10398 #17	Date 2023-10-27	Subject CHIP State Plan Eligibility
CMS Form Number CMS-10143	Date 2023-10-27	Subject State Data for the Medicare Modernization Act (MMA)
CMS Form Number CMS-10780	Date 2023-10-27	Subject Requirements Related to Surprise Billing: Qualifying Payment Amount, Notice and Consent, Disclosure on Patient Protections Against Balance Billing, and State Law Opt-in
CMS Form Number CMS-10450	Date 2023-10-17	Subject Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey for the Merit-Based Incentive Payment System (MIPS)
CMS Form Number CMS-10241	Date 2023-10-16	Subject Survey of Retail Prices
CMS Form Number CMS-10717	Date 2023-10-16	Subject Medicare Part C and Part D Program Audit and Industry-Wide Part C Timeliness Monitoring Project (TMP) Protocols
CMS Form Number CMS-10692	Date 2023-10-04	Subject Home and Community Based Services (HCBS) Incident Management Survey
CMS Form Number CMS-1561 & 1561A	Date 2023-09-29	Subject Health Insurance Benefit Agreement and Supporting Regulations
CMS Form Number CMS-10398 #34	Date 2023-09-27	Subject Model Application Template and Instructions for State Child Health Plan Under Title XXI of the Social Security Act, State Children’s Health Insurance Program
CMS Form Number CMS-10638	Date 2023-09-15	Subject Add-On Payments for New Medical Services and Technologies Paid Under the Inpatient Prospective Payment System (IPPS)
CMS Form Number CMS-R-266	Date 2023-09-13	Subject Medicaid Disproportionate Share Hospital (DSH) Annual Reporting Requirements
CMS Form Number CMS-10769	Date 2023-09-12	Subject Satisfaction of Nursing Homes, Hospitals, and Outpatient Clinicians Working with the CMS Network of Quality Improvement and Innovation Contractors Program (NQIIC)
CMS Form Number CMS-R-21	Date 2023-09-11	Subject Withholding Medicare Payments to Recover Medicaid Overpayments and Supporting Regulations in 42 CFR 447.31
CMS Form Number CMS-855S	Date 2023-09-08	Subject Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Suppliers
CMS Form Number CMS-10865	Date 2023-09-07	Subject Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease
CMS Form Number CMS-10809	Date 2023-08-23	Subject Ambulatory Surgical Center (ASC) Covered Procedure List (CPL) Pre-Proposed Rule Recommendation Request
CMS Form Number CMS-10305	Date 2023-08-11	Subject Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(j)
CMS Form Number CMS-1728-20	Date 2023-07-21	Subject Home Health Agency Cost Report
CMS Form Number CMS-116	Date 2023-07-14	Subject Clinical Laboratory Improvement Amendments (CLIA) Application Form and Supporting Regulations
CMS Form Number CMS-2746	Date 2023-07-14	Subject End Stage Renal Disease (ESRD) Death Notification Form
CMS Form Number CMS-10835	Date 2023-07-13	Subject Dispute Resolution for Discarded Drug Refunds
CMS Form Number CMS-R-26	Date 2023-07-11	Subject Clinical Laboratory Improvement Amendments and ICRs contained in Supporting Regs
CMS Form Number CMS-R-185	Date 2023-07-11	Subject Granting and Withdrawal of Deeming Authority to Private Nonprofit Accreditation Organizations and CLIA Exemption Under State Laboratory
CMS Form Number CMS-10846	Date 2023-07-06	Subject Medicare Part D Manufacturer Discount Program Agreement
CMS Form Number CMS-10569	Date 2023-06-30	Subject Data Collection for Quality Measures Using the End-Stage Renal Disease Quality Reporting System (EQRS)
CMS Form Number CMS-10639	Date 2023-06-30	Subject National Healthcare Safety Network (NHSN) Data Validation Study for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP)
CMS Form Number CMS-10398 #64	Date 2023-06-20	Subject Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta-Analysis Support
CMS Form Number CMS-576A	Date 2023-06-13	Subject Organ Procurement Organization Request for Designation as an OPO Under §1138 of the Social Security Act; and Health Insurance Benefits Agreement
CMS Form Number CMS-10716	Date 2023-06-06	Subject Applicable Integrated Plan Coverage Decision Letter
CMS Form Number CMS-1450	Date 2023-06-06	Subject Medicare Uniform Institutional Provider Bill
CMS Form Number CMS-2728	Date 2023-06-02	Subject End Stage Renal Disease Medical Evidence Report Medicare Entitlement and/or Patient Registration
CMS Form Number CMS-10728	Date 2023-05-30	Subject Value in Opioid Use Disorder Treatment Demonstration
CMS Form Number CMS-10224	Date 2023-05-11	Subject CMS HCPCS Modification to Code Set Form
CMS Form Number CMS-10398 #59	Date 2023-05-04	Subject Medicaid Section 1115 Severe Mental Illness and Children with Serious Emotional Disturbance Demonstrations
CMS Form Number CMS-10853	Date 2023-05-02	Subject Patient Provider Dispute Resolution Requirements Related to Surprise Billing: Part II
CMS Form Number CMS-10857	Date 2023-05-01	Subject Payment Adjustment for Low-Volume Hospitals Under the Hospital Inpatient Prospective Payment System (IPPS)
CMS Form Number CMS-10409	Date 2023-05-01	Subject LTCH CARE Data Set For the Collection of Data Pertaining to the Long-Term Care Hospital Quality Reporting Program
CMS Form Number CMS-10210	Date 2023-05-01	Subject Quality Measures and Procedures for the Hospital Inpatient Quality Reporting Program for the FY 2026 IPPS Annual Payment Updates FY 2024 IPPS/LTCH PPS Proposed Rule
CMS Form Number CMS-10243	Date 2023-04-28	Subject Testing Experience and Functional Tools: Functional Assessment Standardized Items (FASI) Based on the CARE Tool
CMS Form Number CMS-10260	Date 2023-04-28	Subject Medicare Advantage and Prescription Drug Program: Final Marketing Provisions in 42 CFR 422.111(a)(3) and 423.128(a)(3)
CMS Form Number CMS-367A & E	Date 2023-04-28	Subject Medicaid Drug Rebate Program Labeler Reporting Format
CMS Form Number CMS-10410	Date 2023-04-26	Subject Medicaid Program; Eligibility Changes under the Affordable Care Act of 2010
CMS Form Number CMS-10302	Date 2023-04-21	Subject Collection Requirements for Compendia for Determination of Medically-accepted Indications for Off-label Uses of Drugs and Biologicals in an Anti-cancer Chemotherapeutic Regimen
CMS Form Number CMS-10344	Date 2023-04-17	Subject Elimination of Cost Sharing for Full Benefit Dual Eligible Individuals Receiving Home and Community-Based Services
CMS Form Number CMS-10242	Date 2023-04-11	Subject Emergency Ambulance Transports and Beneficiary Signature
CMS Form Number CMS-10036	Date 2023-04-07	Subject IRF-PAI for the collection of data pertaining to the Inpatient Rehabilitation Facility Prospective Payment System and Quality Reporting Program
CMS Form Number CMS-10852	Date 2023-04-04	Subject CoreQ: Short Stay Discharge Survey
CMS Form Number CMS-10108	Date 2023-04-04	Subject Medicaid Managed Care and Supporting Regulations
CMS Form Number CMS-10062	Date 2023-03-30	Subject Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments
CMS Form Number CMS-10275	Date 2023-03-30	Subject CAHPS Home Helath Care Survey
CMS Form Number CMS-10221	Date 2023-03-27	Subject Independent Diagnostic Testing Facilities (IDTFs) Site Investigation Form Revisions
CMS Form Number CMS-437A & 437B	Date 2023-03-10	Subject Rehabilitation Unit & Hospital Criteria Worksheet
CMS Form Number CMS-10834	Date 2023-03-10	Subject Requirement for Electronic Prescribing for Controlled Substances (EPCS) for a Covered Part D Drug Under a Prescription Drug Plan or an MA–PD Plan
CMS Form Number CMS-10836	Date 2023-03-10	Subject Medicare Plan Performance Warning Information
CMS Form Number CMS-416	Date 2023-03-10	Subject Annual Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Participation Report
CMS Form Number CMS-10398 #79	Date 2023-02-10	Subject COVID–19 Risk Corridor Reconciliation Reporting Template
CMS Form Number CMS-10731	Date 2023-02-07	Subject Generic Clearance for CMS and Medicare Administrative Contractor (MAC) Generic Customer Experience
CMS Form Number CMS-R-282	Date 2023-02-07	Subject Medicare Advantage Appeals and Grievance Data Form
CMS Form Number CMS-10609	Date 2023-02-07	Subject Medicaid Program Face-to-Face Requirements for Home Health Services and Supporting Regulations
CMS Form Number CMS-10227	Date 2023-02-07	Subject PACE State Plan Amendment Preprint
CMS Form Number CMS-10824	Date 2023-02-03	Subject Annual Notice of Chance and Evidence of Coverage For Applicable Integrated Plans in States that Require Integrated Materials
CMS Form Number CMS-10830	Date 2023-01-27	Subject Data Collection to Support CMS Burden Reduction and Health Informatics Efforts
CMS Form Number CMS-10595	Date 2023-01-11	Subject Third Party Payment of QHP Premiums and Additional Notices for QHP Issuers Data Collection
CMS Form Number CMS-10594	Date 2023-01-10	Subject Provider Network Coverage Data Collection
CMS Form Number CMS-10823	Date 2022-12-20	Subject End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience
CMS Form Number CMS-R-267	Date 2022-12-14	Subject Medicare Advantage Program and Supporting Regulations
CMS Form Number CMS-R-131	Date 2022-11-25	Subject Advance Beneficiary Notice of Noncoverage (ABN)
CMS Form Number CMS-10816	Date 2022-11-25	Subject Medicare Part C and Medicare Part D Enrollment Form Interviews
CMS Form Number CMS-10556	Date 2022-11-17	Subject Medical Necessity and Contract Amendments Under Mental Health Parity
CMS Form Number CMS-10789	Date 2022-11-04	Subject Customer Satisfaction Survey for Enterprise Portal Services (EPS) Users
CMS Form Number CMS-1771	Date 2022-11-04	Subject Emergency and Foreign Hospital Services and Supporting Regulation in 42 CFR Section 424.103
CMS Form Number CMS-10398 #7	Date 2022-11-01	Subject Connecting Kids to Coverage Outreach and Enrollment
CMS Form Number CMS-10079	Date 2022-10-25	Subject Hospital Wage Index Occupational Mix Survey
CMS Form Number CMS-R-244	Date 2022-10-21	Subject Programs of All-Inclusive Care for the Elderly (PACE) and Supporting Regulations
CMS Form Number CMS-R-5	Date 2022-09-29	Subject Physician Certifications/Recertifications in Skilled Nursing Facilities Manual Instructions
CMS Form Number CMS-10691	Date 2022-09-29	Subject Data Request and Attestation for PDP Sponsors
CMS Form Number CMS-643	Date 2022-09-23	Subject Hospice Survey and Deficiencies Report Form and Supporting Regulations
CMS Form Number CMS-10328	Date 2022-09-07	Subject Medicare Self-Referral Disclosure Protocol
CMS Form Number CMS-10611	Date 2022-08-24	Subject Medicare Outpatient Observation Notice
CMS Form Number CMS-10065 and 10066	Date 2022-08-24	Subject Hospital Notices: IM/DND
CMS Form Number cms-10744	Date 2022-08-05	Subject Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program – Contracting Forms
CMS Form Number CMS-R-305	Date 2022-08-05	Subject External Quality Review (EQR) of Medicaid and Children’s Health Insurance Program (CHIP) Managed Care, EQR Protocols, and Supporting Regulations
CMS Form Number CMS-10553	Date 2022-08-05	Subject Medicaid Managed Care Quality including Supporting Regulations
CMS Form Number CMS-10105	Date 2022-07-15	Subject National Implementation of the In-Center Hemodialysis CAHPS Survey
CMS Form Number CMS-460	Date 2022-07-15	Subject Medicare Participation Agreement for Physicians and Suppliers
CMS Form Number CMS-10052	Date 2022-07-15	Subject Recognition of pass-through payment for additional (new) categories of devices under the Outpatient Prospective Payment System and Supporting Regulations
CMS Form Number CMS-2552-10	Date 2022-06-22	Subject Hospital and Hospital Health Care Complex Cost Report
CMS Form Number CMS-10630	Date 2022-05-10	Subject The PACE Organization (PO) Monitoring and Audit Process in 42 CFR Part 460
CMS Form Number CMS-265-11	Date 2022-05-05	Subject Independent Renal Dialysis Facility Cost Report
CMS Form Number CMS-10544	Date 2022-05-05	Subject Good Cause Processes
CMS Form Number CMS-R-235	Date 2022-04-25	Subject Data Use Agreement (DUA) Form, Research Identifiable Files Request Packet, and Data Management Plan
CMS Form Number CMS-10680	Date 2022-04-13	Subject Electronic Visit Verification Compliance Survey
CMS Form Number CMS-10511	Date 2022-04-06	Subject Medicare Coverage of Items and Services in FDA Investigational Device Exemption Clinical Studies-Revision of Medicare Coverage (CMS-1600-F)
CMS Form Number CMS-10398 #76	Date 2022-03-29	Subject Expressions of interest in the Improving Maternal Health by Reducing Low-Risk Cesarean Delivery Affinity Group
CMS Form Number CMS-10398 #74	Date 2022-03-29	Subject Coverage of Routine Patient Cost for Items & Services in Qualifying Clinical Trials
CMS Form Number CMS-906	Date 2022-03-04	Subject Fiscal Soundness Reporting Requirements (FSRR)
CMS Form Number CMS-10398 #57	Date 2022-02-24	Subject Medicaid Section 1115 Substance Use Disorder (SUD) Demonstration: Monitoring Reports Documents and Templates
CMS Form Number CMS-R-306	Date 2022-02-22	Subject Use of Restraint and Seclusion in Psychiatric Residential Treatment Facilities (PRTFs) for Individuals Under Age 21 and Supporting Regulations
CMS Form Number CMS-R-74	Date 2022-02-22	Subject Income and Eligibility Verification System
CMS Form Number CMS-10575	Date 2022-02-22	Subject Generic Clearance for the Heath Care Payment Learning and Action Network
CMS Form Number CMS-10792	Date 2022-02-22	Subject Patient-Reported Indicator Survey (PaRIS)
CMS Form Number CMS-10786	Date 2022-02-22	Subject SUPPORT Act Section 1003 Demonstration Evaluation
CMS Form Number CMS-3427	Date 2022-02-16	Subject End Stage Renal Disease Application and Survey and Certification Report
CMS Form Number CMS-10793	Date 2022-02-04	Subject Medicare Advantage and Prescription Drug Plan Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey Field Test
CMS Form Number CMS-276	Date 2022-01-18	Subject Prepaid Health Plan Cost Report
CMS Form Number CMS-10398 #13	Date 2022-01-07	Subject Medicaid Accountability – Nursing Facility, Outpatient Hospital and Inpatient Hospital Upper Payment Limits
CMS Form Number CMS-10398 #24	Date 2022-01-07	Subject Medicaid Accountability – Upper Payment Limits for Clinics, Physician Services, ICF/IID, PRTFs, and IMDs
CMS Form Number CMS-10398 #73	Date 2022-01-07	Subject Supplemental Payment Reporting under the Consolidated Appropriations Act, 2021
CMS Form Number CMS-10398 #75	Date 2022-01-07	Subject ARP 1135 State Plan Amendment
CMS Form Number CMS-10476	Date 2022-01-06	Subject Medical Loss Ratio (MLR) Report for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)
CMS Form Number CMS-10802	Date 2022-01-06	Subject Medicare Advantage and Prescription Drug Program: Final Marketing Provisions in 42 CFR 422.111(h)(1)(iii) and 423.128(d)(1)(iii)
CMS Form Number CMS-10799	Date 2022-01-06	Subject D-SNP Enrollee Advisory Committee and SNP Standardized Questions on Health Risk Assessments
CMS Form Number CMS-10554	Date 2022-01-05	Subject Children?s Health Insurance Program Managed Care and Supporting Regulations
CMS Form Number CMS-10633	Date 2021-12-27	Subject QIC Demonstration Evaluation Contractor (QDEC): Analyze Medicare Appeals to Conduct Formal Discussions and Re-openings with Suppliers Appeals to Conduct Formal Discussions and Re-openings With Suppliers
CMS Form Number CMS-2567	Date 2021-10-22	Subject Statement of Deficiencies and Plan of Correction
CMS Form Number CMS-10784	Date 2021-10-14	Subject The Home Health Care CAHPS® Survey (HHCAHPS) Mode Experiment
CMS Form Number CMS-10783	Date 2021-09-28	Subject Generic Beneficiary & Family Centered-Care Quality Improvement Organization (BFCC-QIO) Data Collection Research
CMS Form Number CMS-10787	Date 2021-09-16	Subject Agent and Broker Disclosure and Reporting Requirements
CMS Form Number CMS-10785	Date 2021-09-16	Subject Reporting Requirements Regarding Air Ambulance Services
CMS Form Number CMS-10765	Date 2021-09-08	Subject Review Choice Demonstration for Inpatient Rehabilitation Facility (IRF) Services
CMS Form Number CMS-10775	Date 2021-08-06	Subject Medicare Severity Diagnosis Related Groups Reclassification Request (MS-DRGs)
CMS Form Number CMS-10398 #72	Date 2021-07-30	Subject Expressions of Interest in the Infant Well-Child Visit Affinity Group
CMS Form Number CMS-10701	Date 2021-07-29	Subject Medicare Beneficiary Experiences with Care Survey (MBECS) System
CMS Form Number CMS-10781	Date 2021-07-23	Subject FOIA/Privacy Act Requests for Medicare Claims Data via CMS FOIA Public Portal
CMS Form Number CMS-10572	Date 2021-07-23	Subject Transparency in Coverage Reporting by Qualified Health Plan Issuers
CMS Form Number CMS-10398 #69	Date 2021-05-20	Subject Reporting Requirements for Additional Funding for Medicaid HCBS During the COVID–19 Emergency
CMS Form Number CMS-10398 #71	Date 2021-05-17	Subject Reporting Requirements for State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services During the COVID–19 Emergency
CMS Form Number CMS-10398	Date 2021-03-19	Subject Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions
CMS Form Number CMS-10198	Date 2021-03-18	Subject Creditable Coverage Disclosure to CMS On-Line Form and Instructions
CMS Form Number CMS-1763	Date 2021-02-05	Subject Request for Termination of Premium Hospital and Supplementary Medical Insurance
CMS Form Number CMS-10518	Date 2021-02-01	Subject Application for Participation in the Intravenous Immune Globulin (IVIG) Demonstration
CMS Form Number CMS-10434	Date 2019-08-15	Subject Medicaid and CHIP Program (MACPro)
CMS Form Number	Date	Subject

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