Medicare and Medicaid Programs; Electronic Health Record Incentive Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
195516	42 CFR 495.366 -- average		Modified
195515	42 CFR 495.352 -- average		Modified
195514	42 CFR 495.350--average		Modified
195513	42 CFR 495.348(f)		Modified
195512	42 CFR 495.348(e)		Modified
195511	42 CFR 495.348(c)		Modified
195510	42 CFR 495.330(a) - average		Modified
195509	42 CFR 495.316		Modified
195508	42 CFR 495.306(a)(2)		Modified
195507	42 CFR 495.306(a)(1)(ii)(B)		Modified
195506	42 CFR 495.306(a)(1)(ii)(A)		Modified
195505	42 CFR 495.306(a)(1)(i)		Modified
195504	42 CFR 495.210(b) (2012) EPs-attestation		Modified
195503	42 CFR 495.204(b)(5) or (b)(6)(2012) EPs-salary		Modified
195502	42 CFR 495.204(b)(4) (2012) EPs-method		Modified
195501	42 CFR 495.204(b)(2) (2012) Revenue reporting		Modified
195500	42 CFR 495.202(b)(2) (2012) MA-affiliated hospitals-final ID		Modified
195499	42 CFR 495.202(b)(2) (2012) EPs-final ID		Modified
195498	42 CFR 495.202(b)(2) (2012) MA-affiliated hospitals-preliminary ID		Modified
195497	42 CFR 495.202(b)(2) (2012) EPs-preliminary ID		Modified
195496	42 CFR 495.10(d) - (hospital) (2012)		Modified
195495	42 CFR 495.10(a) (b) (hospital) (2011)		Modified
195494	42 CFR 495.10(e)(2) - (EPs) (2012) average		Modified
195493	42 CFR 495.10(e)(1) - (EPs) (2011) average		Modified
195492	42 CFR 495.10(d) - (EPs) (2012) average		Modified
195491	42 CFR 495.10(a)-(c) -- (EPs) (2011) average		Modified
195490	42 CFR 495.8 (b)(2)- Hospital Quality Measures (hospitals/CAHs) (2012)		Modified
195489	42 CFR 495.8 (b)(2)- Menu Set Objectives/ Measures average (hospitals/CAHs) (2012)		Modified
195488	42 CFR 495.8 (b)(2)-- EHR Technology Used & Core Set Objectives/Measures (hospitals/CAHs) (2012)		Modified
195487	42 CFR 495.8(b)(1) - Menu Set Objectives/ Measures average (hospitals/CAHs) (2011)		Modified
195486	42 CFR 495.8 (b)(1)-- EHR Technology Used, Core Set Objectives/Measures & Quality Measures (hospitals/CAHs) (2011)		Modified
195485	42 CFR 495.8 (a)(2)- Ambulatory Quality Measures (EPs) (2012)		Modified
195484	42 CFR 495.8 (a)(2)- Menu Set Objectives/ Measures average (EPs) (2012)		Modified
195483	42 CFR 495.8(a)(2) - EHR Technology Used & Core Set Objectives/Measures (EPs) (2012)		Modified
195482	42 CFR 495.8 (a)(1)- Menu Set Objectives/Measures average (EPs) (2011)		Modified
195481	42 CFR 495.8 (a)(1)- EHR Technology Used, Core Set Objectives/Measures & Quality Measures (EPs) (2011)		Modified

ICR Details

OMB Control No: 0938-1158	ICR Reference No: 201108-0938-001
Status: Historical Active	Previous ICR Reference No: 201012-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare and Medicaid Programs; Electronic Health Record Incentive Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/21/2012
	Date Received in OIRA: 08/15/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2013	36 Months From Approved
Responses	3,851,294	0	0
Time Burden (Hours)	4,109,447	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Recovery Act expands the use of health information technology (HIT) and certified electronic health records (EHRs) to improve the quality and value of health care. The Recovery Act establishes incentive payments to Medicare, Medicaid, and Medicare Advantage Organization (MAO)-affiliated eligible professionals (EPs) and eligible hospitals and critical access hospitals (CAHs) to promote the adoption and meaningful use (MU) of interoperable HIT and EHRs. These provisions, together with Title XIII of Division A of the Recovery Act, may be cited as the "Health Information Technology for Economic and Clinical Health Act" or "HITECH Act" which authorizes CMS to develop the incentive programs, key to enticing providers to use HIT. All proposed information collection requirements are necessary to implement the HITECH Act. With this submission, we are creating a new PRA package for Medicare and Medicaid eligible professionals (EPs), eligible hospitals and CAHs. The functionality of certified EHR technology facilitates the implementation of meaningful use.

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Authorizing Statute(s): PL: Pub.L. 111 - 5 Title XIII:130001-13424 Name of Law: The American Recovery and Reinvestment Act of 2009
   PL: Pub.L. 111 - 5 Subtitle A - Section 3006 Name of Law: Health Information Technology for Economic and Clinical Health Act
   PL: Pub.L. 111 - 5 4101 Name of Law: Incentives for Eligible Professionals
   PL: Pub.L. 111 - 5 4103 Name of Law: Treatment of payments and savings; impelmentation funding
   PL: Pub.L. 111 - 5 4201 Name of Law: Medicaid Provider HIT adoption and operation payemtns; implementation funding
   PL: Pub.L. 111 - 5 4102 Name of Law: Incentives for Hospitals
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 5 4102 Name of Law: Incentives for Hospitals
PL: Pub.L. 111 - 5 Subtitle A - Section 3006 Name of Law: Health Information Technology for Economic and Clinical Health Act
PL: Pub.L. 111 - 5 4101 Name of Law: Incentives for Eligible Professionals
PL: Pub.L. 111 - 5 4103 Name of Law: Treatment of payments and savings; impelmentation funding
PL: Pub.L. 111 - 5 4201 Name of Law: Medicaid Provider HIT adoption and operation payemtns; implementation funding
PL: Pub.L. 111 - 5 Title XIII:130001-13424 Name of Law: The American Recovery and Reinvestment Act of 2009

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking
	Other Documents for OIRA Review

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 44314	07/23/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 65354	10/22/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 36

table that charts list of burden

IC Title	Form No.	Form Name
42 CFR 495.8 (a)(2)- Menu Set Objectives/ Measures average (EPs) (2012)
42 CFR 495.8 (a)(2)- Ambulatory Quality Measures (EPs) (2012)
42 CFR 495.8 (b)(1)-- EHR Technology Used, Core Set Objectives/Measures & Quality Measures (hospitals/CAHs) (2011)
42 CFR 495.8(b)(1) - Menu Set Objectives/ Measures average (hospitals/CAHs) (2011)
42 CFR 495.8 (b)(2)-- EHR Technology Used & Core Set Objectives/Measures (hospitals/CAHs) (2012)
42 CFR 495.8 (b)(2)- Menu Set Objectives/ Measures average (hospitals/CAHs) (2012)
42 CFR 495.8 (a)(1)- EHR Technology Used, Core Set Objectives/Measures & Quality Measures (EPs) (2011)
42 CFR 495.8 (a)(1)- Menu Set Objectives/Measures average (EPs) (2011)
42 CFR 495.8(a)(2) - EHR Technology Used & Core Set Objectives/Measures (EPs) (2012)
42 CFR 495.8 (b)(2)- Hospital Quality Measures (hospitals/CAHs) (2012)
42 CFR 495.10(a)-(c) -- (EPs) (2011) average
42 CFR 495.10(d) - (EPs) (2012) average
42 CFR 495.10(e)(1) - (EPs) (2011) average
42 CFR 495.10(e)(2) - (EPs) (2012) average
42 CFR 495.10(a) (b) (hospital) (2011)
42 CFR 495.10(d) - (hospital) (2012)
42 CFR 495.202(b)(2) (2012) EPs-preliminary ID
42 CFR 495.348(f)
42 CFR 495.350--average
42 CFR 495.352 -- average
42 CFR 495.366 -- average
42 CFR 495.202(b)(2) (2012) MA-affiliated hospitals-preliminary ID
42 CFR 495.202(b)(2) (2012) EPs-final ID
42 CFR 495.202(b)(2) (2012) MA-affiliated hospitals-final ID
42 CFR 495.204(b)(2) (2012) Revenue reporting
42 CFR 495.204(b)(4) (2012) EPs-method
42 CFR 495.204(b)(5) or (b)(6)(2012) EPs-salary
42 CFR 495.210(b) (2012) EPs-attestation
42 CFR 495.306(a)(1)(i)
42 CFR 495.306(a)(1)(ii)(A)
42 CFR 495.306(a)(1)(ii)(B)
42 CFR 495.306(a)(2)
42 CFR 495.316
42 CFR 495.330(a) - average
42 CFR 495.348(c)
42 CFR 495.348(e)

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ICR Summary of Burden

table that charts list 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	3,851,294	0	3,851,294	0	0	0
Annual Time Burden (Hours)	4,109,447	0	4,109,447	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: This is a new collection.

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Annual Cost to Federal Government: $13,333,333

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]? 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)? Yes

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: 08/12/2011

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