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Measure Implementation


Section 3014 of the Patient Protection and Affordable Care Act of 2010 (ACA) (P.L. 111-148) created section 1890A of the Social Security Act (the Act), which required the U.S. Department of Health and Human Services (HHS) to establish a federal pre-rulemaking process for the selection of quality and efficiency measures for use by HHS. Section 1890(b)(7)(B) of the Act describes the categories of measures.

The pre-rulemaking process includes five major steps:

  1. Each year CMS invites measure developers/stewards to submit candidate measures through the CMS MERIT. The submission period closes on a prescribed date to allow HHS time to review and make their selection of measures to place on the CMS MUC List.
  2. Annually, no later than December 1, HHS makes publicly available a list of quality and efficiency measures that HHS is considering adopting, through the federal rulemaking process, for use in Medicare program(s).
  3. Multi-stakeholder groups provide recommendations to HHS no later than February 1 annually on the quality and efficiency measures under consideration.
  4. HHS considers the multi-stakeholder groups’ input in selecting candidate quality and efficiency measures.
  5. HHS selects candidate measures and publishes proposed rules in the Federal Register, which allows for public comment and further consideration before a final rule is issued. If the CMS consensus-based entity has not endorsed a candidate measure, then HHS must include a rationale for the use of the measure in the notice.

Click image to enlarge. 

Pre-Rulemaking Table

Contact for More Information

For more information about the pre-rulemaking process, inquiries about measures submitted for the most recent cycle, or questions on other general measure topics, please email

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