Hospice Item Set

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10390 Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	Form and Instruction	Modified	Available
Exhibit B - Burden Calculations from 2013 Hospice Rule PRA Package (draft).docx	Supplementary Document	Uploaded 2013-05-28	Repair queued
Hospice PRA Burden Estimate.03.27.13.docx	Supplementary Document	Uploaded 2013-05-28	Available
Hospice_QRP_Data_Entry_Tech_Guide_v1.3.pdf	Supplementary Document	Uploaded 2012-08-07	Available
Y1_User_Guide_2012 - REVISED 0209 dates 8-2-12.pdf	Supplementary Document	Uploaded 2012-08-07	Available
CMS-10390 Supporting Statement A. 03.27.13.docx	Supporting Statement A	Uploaded 2013-05-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
203679	Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1153	ICR Reference No: 201307-0938-020
Status: Historical Inactive	Previous ICR Reference No: 201208-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: 19693
Title: Hospice Item Set
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule	Conclusion Date: 03/24/2014
	Date Received in OIRA: 07/25/2013
Terms of Clearance: Comment Filed

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved	09/30/2015
Responses	0	0	3,632
Time Burden (Hours)	0	0	657,392
Cost Burden (Dollars)	0	0	0

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Abstract: Section 1814(i)(5) of the Social Security Act added by section 3004 of the Patient Protection and Affordable Care Act, Pub. L. 111 148, enacted on March 23, 2010 (Affordable Care Act), authorizes the Secretary to establish a quality reporting program for hospices. Section 1814(i)(5)(A)(i) of the Social Security Act requires that the Secretary, beginning with FY 2014, reduce the market basket update by 2 percentage points for any hospice that does not submit quality data submission for a fiscal year. CMS established the Hospice Quality Reporting Program (HQRP) in the FY 2012 Hospice Wage Index final rule (76 FR 47318 through 47324, and 47325 through 47326) pursuant to Section 3004 of the Affordable Care Act. In this rule, CMS set forth the initial framework for the HQRP and established that the first "mandatory" reporting period would take place from October 1, 2012 through December 31, 2012. During the first "mandatory" reporting period, hospices were required to gather data pertaining to two quality measures: (1) a structural measure titled "Participation in a Quality Assessment and Performance Improvement (QAPI) Program that Includes at Least Three Quality Indicators Related to Patient Care" and; (2) the NQF-endorsed #0209 pain measure. Hospice providers were then required to report their data between 01/01/2012 and 04/01/2012 In the CY 2013 HH PPS final rule (77 FR 67132 through 67136) CMS retained the two measures that had previously been adopted in the FY 2012 rule. For FY 2016 data submission requirements, CMS is proposing that beginning July 1, 2014, hospices collect a newly created set of data elements, the Hospice Item Set, as part of the HQRP instead of the previous two measures.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3004 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AR64	Proposed rulemaking	78 FR 27823	05/10/2013

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	CMS-10390, CMS-10390, CMS-10390, CMS-10390	Hospice Item Set - Admission ,   Hospice Item Set ,   Crosswalk ,   Hospice Item Set - Discharge

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: The first reporting period in which the new IRC will be implemented will begin on July, 1, 2014 and end on December 31, 2014. This IRC form will be used in subsequent reporting periods thereafter. There will be a change in the burden caused by the revision of the currently existing ICR as well as changes in the measures used with the Hospice Quality Reporting Program

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Annual Cost to Federal Government: $250,000

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: 07/25/2013

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