Hospice Conditions of Participation

Forms and Documents

Document Name	Status
CMS-10277 Supporting_Statement_Part_A -FINAL.doc Supporting Statement A	2010-11-30

IC Document Collections

IC ID	Document Title	Status
195470	Hospice Certification of Terminal Illness (418.22): Including Benefit Periods	New
195469	Hospice Certification of Terminal Illness (418.22): Completion of Attestation Form	New
195468	Hospice Certification of Terminal Illness (418.22, first year): Development of Attestation Form	New
189585	Hospice Conditions of Participation (418.114 - annual)	Modified
189584	Hospice Conditions of Participation (418.114 - first year)	Modified
189583	Hospice Conditions of Participation (418.112)	Modified
189582	Hospice Conditions of Participation (418.110 - annual)	Modified
189581	Hospice Conditions of Participation (418.110 - first year)	Modified
189580	Hospice Conditions of Participation (418.106)	Modified
189579	Hospice Conditions of Participation (418.78)	Modified
189578	Hospice Conditions of Participation (418.76)	Modified
189577	Hospice Conditions of Participation (418.56)	Modified
189576	Hospice Conditions of Participation (418.52)	Modified

ICR Details

OMB Control No: 0938-1067	ICR Reference No: 201011-0938-017
Status: Historical Active	Previous ICR Reference No: 200906-0938-010
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Hospice Conditions of Participation
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: 01/10/2011
	Date Received in OIRA: 11/30/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2014	36 Months From Approved	09/30/2012
Responses	2,223,194	0	28,720
Time Burden (Hours)	1,360,214	0	1,339,383
Cost Burden (Dollars)	0	0	0

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Abstract: The CoPs and accompanying requirements specified in the regulations are used by Federal or State surveyors as a basis for determining whether a hospice qualifies for approval or re-approval under Medicare. CMS and the healthcare industry believe that the availability to the hospice of the type of records and general content of records, which this regulation specifies, is standard medical practice, and is necessary in order to ensure the well-being and safety of patients and professional treatment accountability.

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Authorizing Statute(s): US Code: 42 USC 1395x Name of Law: Hospice Care; Hospice Program
   PL: Pub.L. 97 - 248 122 Name of Law: Tax Equity & Fiscal Responsibility Act
   PL: Pub.L. 101 - 239 6005(b) Name of Law: Omnibus Reconciliation Act of 1989
   PL: Pub.L. 105 - 33 Title IV, Chapter 4 Name of Law: BBA of 1997
   PL: Pub.L. 108 - 173 946 Name of Law: Medicare Prescription Drug, Improvement, & Modernization Act of 2003
  

Citations for New Statutory Requirements: US Code: 42 USC 1395x Name of Law: Hospice Care; Hospice Program

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AP88	Final or interim final rulemaking	75 FR 70372	11/17/2010

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 43236	07/23/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 70372	11/17/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 13

IC Title	Form No.	Form Name
Hospice Conditions of Participation (418.78)
Hospice Conditions of Participation (418.106)
Hospice Conditions of Participation (418.110 - first year)
Hospice Conditions of Participation (418.52)
Hospice Conditions of Participation (418.56)
Hospice Conditions of Participation (418.76)
Hospice Conditions of Participation (418.110 - annual)
Hospice Conditions of Participation (418.112)
Hospice Conditions of Participation (418.114 - first year)
Hospice Conditions of Participation (418.114 - annual)
Hospice Certification of Terminal Illness (418.22, first year): Development of Attestation Form
Hospice Certification of Terminal Illness (418.22): Completion of Attestation Form
Hospice Certification of Terminal Illness (418.22): Including Benefit Periods

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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	2,223,194	28,720	2,194,474	0	0	0
Annual Time Burden (Hours)	1,360,214	1,339,383	20,831	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: No

Burden Reduction Due to:

Short Statement: The burden has been revised since the last approved OMB submission, however it has not been revised since the submission of this package when the proposed rule published.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? Yes

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

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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: 11/30/2010

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