Submission of Information for the Hospital Outpatient Quality Data Reporting Program (CMS-10250)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10250 Submission of Information for the Hospital Outpatient Quality Data Reporting Program	Form and Instruction	New	Repair queued
Form CMS-10250 Submission of Information for the Hospital Outpatient Quality Data Reporting Program	Form and Instruction	New	Repair queued
CMS-10250.REVISED Supporting Statement Part B.doc	Supporting Statement B	Uploaded 2009-01-22	Repair queued
09 HOPQDRP_SpecsMan_v[1].2.0c.pdf	Supplementary Document	Uploaded 2009-01-22	Repair queued
08 HOP_ManualFinal_10[1].pdf	Supplementary Document	Uploaded 2009-01-22	Repair queued
CMS-10250.REVISED Supporting Statement Part A.doc	Supporting Statement A	Uploaded 2009-01-22	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
188916	Submission of Information for the Hospital Outpatient Quality Data Reporting Program	Form and Instruction	New
188915	Submission of Information for the Hospital Outpatient Quality Data Reporting Program	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 200904-0938-012
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Submission of Information for the Hospital Outpatient Quality Data Reporting Program (CMS-10250)
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 10/23/2009
	Date Received in OIRA: 04/23/2009
Terms of Clearance: This ICR is withdrawn per agency request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 109 (Title I) of the Tax Relief and Health Care Act of 2006 (PL 109-432) (TRHCA) modifies Section 1833(t) of the Social Security Act (the "Act") and sets out new requirements for reporting hospital outpatient department quality data. The Act amends Section 1833(t) of the Social Security Act and provides that, beginning with the payment update for FY 2009 and applying to each subsequent calendar year, the annual of the Outpatient Department (OPD) fee schedule increase amount will be reduced by 2.0 percentage points for any "subsection (d) hospital" that does not submit required quality data, specified by the Secretary. This program is being developed to parallel to the extent practical the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) Program.

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Authorizing Statute(s): US Code: 42 USC 1395(l) Name of Law: Prospective payment system for hospital outpatient department services
   PL: Pub.L. 109 - 432 Division B Name of Law: Quality reporting for hospital outpatient services and ambulatory surgical center services.
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AO71	Final or interim final rulemaking	72 FR 66580	11/27/2007

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 57034	10/05/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 71141	12/14/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Submission of Information for the Hospital Outpatient Quality Data Reporting Program	CMS-10250, CMS-10250	CMS-10250.HOPQDRP Attestation Form with Disclosure Statement ,   CMS-10250.Notice of Participation with Disclosure Statement
Submission of Information for the Hospital Outpatient Quality Data Reporting Program	CMS-10250, CMS-10250	CMS-10250.HOPQDRP Attestation Form with Disclosure Statement ,   CMS-10250.Notice of Participation with Disclosure Statement

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

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: 04/23/2009

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