Data Collection for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration

Forms and Documents

Document Name	Status
Supporting Statement B.docx Supporting Statement B	2010-08-19
crosswalk-NHVBP.docx Supplementary Document	2010-08-19
Supporting A.docx Supporting Statement A	2010-08-19

IC Document Collections

IC ID	Document Title	Status
182817	Data Collection for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration: ONGOING DATA (CMS-10240) Other-Application, Survey, Data collection Form, Statistical Met	Removed
182816	Data Collection for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration: ONGOING DATA(CMS-10240) Other-Form and Instructions	Modified

ICR Details

OMB Control No: 0938-1039	ICR Reference No: 201009-0938-004
Status: Historical Active	Previous ICR Reference No: 200711-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Data Collection for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/09/2010
	Date Received in OIRA: 09/20/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2013	36 Months From Approved	03/31/2011
Responses	712	0	2,000
Time Burden (Hours)	5,530	0	49,170
Cost Burden (Dollars)	0	0	400,000

---

Abstract: The NHVBP Demonstration is a CMS "pay-for-performance" initiative to improve the quality of care furnished to Medicare beneficiaries residing in nursing homes. Under this three-year demonstration project, CMS will assess the performance of nursing homes based on selected quality measures, and then make payments to those nursing homes that achieve a higher performance based on those measures. Quality will be assessed based on the following four domains: staffing, appropriate hospitalizations, outcome measures from the minimum data set (MDS), and survey deficiencies.

---

Authorizing Statute(s): US Code: 42 USC 1395b-1(b) Name of Law: null
   US Code: 42 USC 1395b-1(a)(1)(A) Name of Law: null
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 30030	05/28/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 49494	08/13/2010
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Data Collection for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration: ONGOING DATA(CMS-10240)
Data Collection for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration: ONGOING DATA (CMS-10240)

---

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	712	2,000	0	-1,288	0	0
Annual Time Burden (Hours)	5,530	49,170	0	-43,640	0	0
Annual Cost Burden (Dollars)	0	400,000	0	-400,000	0	0

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: When CMS submitted the original supporting statement for this data collection, we estimated that there would be 250 participants (submitting 4 responses annual, yielding 1,000 annual responses) and an annual burden of 17,220 hours. We also estimated that there would be 1,000 applicants for the demonstration, at a total burden of 31,950 hours. These estimates were based on a pre-demonstration survey of 9 nursing homes. We have revised the annual burden estimates for this supporting statement. These estimates are substantially lower than our original estimates, for two reasons. First, the actual number of demonstration participants is 178 (submitting 4 responses annually, yielding 712 annual responses). Second, 69 participants reported their actual burden. Based on this information, we estimated an annual burden of 5,530 hours (i.e., an average of 7.75 hours per response for 712 responses). In addition, the initial collection (i.e., the application) has ended. So the burden associated with the initial collection (1,000 responses at 31,950 hours) is no longer included in the current burden estimate.

---

Annual Cost to Federal Government: $40,000

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

---

Common Form ICR:  No

---

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: 09/20/2010

---