Surveys of Physicians and Home Health Agencies to Assess Access Issues for Specific Medicare Beneficiaries as Defined in Section 3131(d) of the ACA

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10429 (Home Health Agencies) Survey of Access to Home Health Services for Medicare Beneficiaries	Form	New	Available
Supporting Statement PartB REVISED 11-19-12.pdf	Supporting Statement B	Uploaded 2012-12-04	Available
Supporting Statement PartA REVISED 11-19-2012.pdf	Supporting Statement A	Uploaded 2012-12-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202896	(Home Health Agencies) Survey of Access to Home Health Services for Medicare Beneficiaries	Form	New
202895	(Physician) Survey of Access to Home Health Services for Medicare Beneficiaries	Other-Post Card	New

ICR Details

OMB Control No: 0938-1183	ICR Reference No: 201206-0938-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Surveys of Physicians and Home Health Agencies to Assess Access Issues for Specific Medicare Beneficiaries as Defined in Section 3131(d) of the ACA
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: 12/11/2012
	Date Received in OIRA: 06/27/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2015	36 Months From Approved
Responses	875	0	0
Time Burden (Hours)	219	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Centers for Medicare and Medicaid Services (CMS) has contracted with L&M Policy Research (L&M) and its partners, Avalere Health (Avalere), Mathematica Policy Research (MPR), and Social & Scientific Systems, Inc. (SSS) to support the Agency in responding to provisions of the Patient Protection and Affordable Care Act (ACA) Section 3131(d) and concerns that some subsets of the Medicare population may have decreased access to home health services. Findings from this project may result in revisions to the home health prospective payment system (HH PPS) to ensure that home health agencies (HHAs) are adequately reimbursed for providing services to vulnerable populations as defined by the ACA - low income beneficiaries, those living in medically underserved areas, and beneficiaries with high levels of severity of illness. The research team plans to conduct two surveys in order to help identify characteristics of beneficiaries who are difficult to place in home health care. To learn more about the beneficiaries who experience access issues, respondent specific surveys have been developed to administer to (1) physicians who refer vulnerable patients to the Medicare home health benefit, and (2) Medicare certified home health agencies. Both target populations offer unique perspectives on the characteristics of Medicare beneficiaries who may have access issues and can help answer questions that cannot be addressed as well through other research methods (primarily through analysis of administrative claims).

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 3131(d) Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 3131(d) Name of Law: Patient Protection and Affordable Care Act

---

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:
	77 FR 23264	04/18/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 38298	06/27/2012
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
(Home Health Agencies) Survey of Access to Home Health Services for Medicare Beneficiaries	CMS-10429	(Home Health Agencies) Survey of Access to Home Health Services for Medicare Beneficiaries
(Physician) Survey of Access to Home Health Services for Medicare Beneficiaries	CMS-10429	(Physician) Survey of Access to Home Health Services for Medicare Beneficiaries

---

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	875	0	875	0	0	0
Annual Time Burden (Hours)	219	0	219	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 colelction.

---

Annual Cost to Federal Government: $148,509

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]? 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

---

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: 06/27/2012

---