CAHPS Home Health Care Survey

Forms and Documents

Document Name	Status
Form CMS-10275 HHCAHPS Participation Exemption Request Form Form	New
Form CMS-10275 CAHPS Home Health Care Survey (CMS-10275) Form	Modified
HomeHealthCAHPS_OMB_PartB revised 6-10-13.doc Supporting Statement B	2013-09-26
HHCAHPS_LeadLetter2_English.pdf Supplementary Document	2013-09-26
HHCAHPS_LeadLetter1_English.pdf Supplementary Document	2013-09-26
HomeHealthCAHPS_OMB_PartA [rev 9-26-2013 by OSORA PRA].doc Supporting Statement A	2013-09-26

IC Document Collections

IC ID	Document Title	Status
208859	HHCAHPS Participation Exemption Request Form Form	New
195477	Patient Assessment Data	Modified
188901	CAHPS Home Health Care Survey (CMS-10275) Form	Modified

ICR Details

OMB Control No: 0938-1066	ICR Reference No: 201309-0938-032
Status: Historical Inactive	Previous ICR Reference No: 201011-0938-018
Agency/Subagency: HHS/CMS	Agency Tracking No: 20616
Title: CAHPS Home Health Care Survey
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 and continue	Conclusion Date: 01/15/2014
	Date Received in OIRA: 09/30/2013
Terms of Clearance: Comment filed.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2014	36 Months From Approved	05/31/2014
Responses	2,715,890	0	2,715,890
Time Burden (Hours)	699,440	0	699,440
Cost Burden (Dollars)	39,560,000	0	39,560,000

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Abstract: In 2001, the Quality Initiative was implemented in HHS to ensure the quality of health care for all Americans through accountability and public disclosure. The goals of the initiative are to empower consumers with quality-of-care information so they can make more informed decisions about their health care and to stimulate and support providers and clinicians to improve the quality of health care. The Quality Initiative was launched nationally in November 2002 for nursing homes and was expanded to home health agencies (the Home Health Quality Initiative) in 2003. A major gap in the information currently available regarding the quality of home health care is the lack of information from the patient perspective. As part of the DHHS Transparency Initiative on Quality Reporting, CMS plans to implement a process to measure and publicly report patients' experiences with home health care they receive from Medicare-certified home health agencies through the data collection effort described in this request: the Consumer Assessment of Healthcare Providers and Systems (CAHPS?) Home Health Care Survey. The Home Health Care CAHPS Survey, which was developed and tested by the Agency for Healthcare Research and Quality (AHRQ) and is part of the family of CAHPS surveys, is a standardized survey for home health patients to assess their home health care providers and the quality of the home health care they receive. Prior to the Home Health Care CAHPS survey, there was no national standard for collecting data about home health care patients' experience with their home health care. This is a revision to the original PRA package which covered the voluntary implementation of the survey among Medicare-certified agencies and a randomized mode experiment to test the impact of different modes of data collection on survey responses.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: US Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AR52	Proposed rulemaking	78 FR 40271	07/03/2013

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 40271	07/03/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
CAHPS Home Health Care Survey (CMS-10275)	CMS-10275, CMS-10275, CMS-10275, CMS-10275, CMS-10275	CAHPS Home Health Care Survey ,   CAHPS Home Health Care Survey (Russian) ,   CAHPS Home Health Care Survey (Spanish) ,   CAHPS Home Health Care Survey (Telephone/Proxy) ,   CAHPS Home Health Care Survey (Telephone)
Patient Assessment Data
HHCAHPS Participation Exemption Request Form	CMS-10275	HHCAHPS Participation Exemption Request Form

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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 HHAs have some burden in the HHCAHPS that was NOT included in the last PRA package. We require small home health agencies that serve 59 or fewer patients in an annual period to complete an HHCAHPS Participation Exemption Request Form annually, for every CY Annual Payment Update period. Currently, we have posted the HHCAHPS Participation Exemption Request Form for the CY 2015 Annual Payment Update. If home health agencies have served 59 or fewer HHCAHPS eligible patients in the period of April 2012 through March 2013, then they are required to complete the HHCAHPS Participation Exemption Request Form for CY 2015 if they want to be exempt from HHCAHPS participation from April 2013 through March 2014. Although we have explained the usage of the participation exemption form for the past five years in federal regulation we have not declared the burden of completing the form to small home health agencies. We are additionally attaching the current version of the HHCAHPS in all languages that it is approved for use. In the prior OMB package, we only included the English version of the HHCAHPS survey. The number of individuals completing the survey has been adjusted from 2,706,000 to 2,967,000. The program chnage consists of an additional 1,160 hours and $21,112 for the 2,000 HHAs completing the Participation Exemption form. Finally, while reported in Supporting Statement part A, $39,560,000 has been removed from the burden table since those costs are labor-specific.

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Annual Cost to Federal Government: $1,854,800

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

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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: 09/30/2013

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