Inpatient Psychiatric Facility Quality Reporting Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10432 Withdrawal of Participation	Form and Instruction	Modified	Available
Form CMS-10432 Vendor Authorization	Form and Instruction	Modified	Available
Form CMS-10432 Vendor Authorization Screen Shot	Form and Instruction	Modified	Available
Form CMS-10432 Notice of Participation	Form and Instruction	Modified	Available
Form CMS-10432 Notice of Partication Screen Shot	Form and Instruction	Modified	Available
Form CMS-10432 Extroadinary Circumstance/Waiver Request Form	Form and Instruction	Modified	Available
Form CMS-10432 Decline to Participate	Form and Instruction	Modified	Available
Form CMS-10432 HBIPS-2 Measure Screen Shot	Form and Instruction	Modified	Repair queued
Form CMS-10432 HBIS Structural Measure Data Collection	Form and Instruction	Modified	Available
Form CMS-10432 Data Accuracy and Completeness Screen Shot	Form and Instruction	Modified	Available
Form CMS-10432 Data Accuracy and Completeness	Form and Instruction	Modified	Available
Form CMS-10432 Reconsideration Request Form	Form and Instruction	Modified	Available
IPFQR_Notification Letter_Aug_26_2012.docx	Supplementary Document	Uploaded 2013-10-30	Available
CMS IPF Crosswalk_508.pdf	Supplementary Document	Uploaded 2013-10-30	Available
CMS IPF Supporting Statement A_updated on 2013_04_01_508.pdf	Supporting Statement A	Uploaded 2013-10-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Withdrawal of Participation
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Vendor Authorization
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Vendor Authorization Screen Shot
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Notice of Participation
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Notice of Partication Screen Shot
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Extroadinary Circumstance/Waiver Request Form
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Decline to Participate
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	HBIPS-2 Measure Screen Shot
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	HBIS Structural Measure Data Collection
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Data Accuracy and Completeness Screen Shot
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Data Accuracy and Completeness
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Reconsideration Request Form

ICR Details

OMB Control No: 0938-1171	ICR Reference No: 201310-0938-011
Status: Historical Active	Previous ICR Reference No: 201209-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No: 20794
Title: Inpatient Psychiatric Facility Quality Reporting Program
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: 02/14/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/30/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2017	36 Months From Approved	12/31/2015
Responses	596,200	0	471,811
Time Burden (Hours)	2,279,200	0	1,415,433
Cost Burden (Dollars)	0	0	0

---

Abstract: Section 10322 of the Affordable Care Act authorizes the establishment of a new quality reporting program for Inpatient Psychiatric Facilities (IPFs). It builds on a voluntary Inpatient Psychiatric Facilities Quality Reporting (IPFQR) program which remains in effect. The IPFQR began with an initial set of 6 measures for FY 2014 and FY 2015 and for the IPPS 2016 and subsequent years; will add an additional 4 for a total of 10 IPFQR measures.IPFs failing to submit the quality measures will receive a 2% reduction in their Annual Payment Update (APU). In an effort to minimize burden and maximize efficiency, CMS has leveraged existing systems within CMS to collect aggregated and calculated measure rates from the IPFs, in a form, manner and time as specified by CMS, via a secure portal known as the QualityNet Web site beginning of October 1, 2012 for FY2014 payment determination year. These procedural requirements involve submitting necessary forms (e.g. Notice of Participation Form, Reconsideration Request Form, Disaster Waiver Form, etc.) to comply with the IPFQR Program and align with current CMS reporting requirements for other hospital quality reporting programs. When adding new measures, the law requires CMS, when "feasible and practical" to select measures put forward by "one or more national consensus building entities". Section 3013 of the Affordable Care Act (ACA) modified by Section 931 of the Public Health Service Act requires CMS to perform a gap analysis for needed quality measures every three years. Section 3014 of the ACA modified Section 1890(b) of the Social Security Act requires CMS to develop quality and efficiency measures through a "consensus-based entity". Consequently, the Measure Applications Partnership (MAP), convened by the National Quality Forum (NQF), was formed to develop measures consistent with these requirements.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 10322 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AR15	Final or interim final rulemaking	78 FR 50497	08/19/2013

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Inpatient Psychiatric Facility Quality Reporting Program	CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432	Reconsideration Request Form ,   Data Accuracy and Completeness ,   Data Accuracy and Completeness Screen Shot ,   HBIS Structural Measure Data Collection ,   HBIPS-2 Measure Screen Shot ,   Decline to Participate ,   Extroadinary Circumstance/Waiver Request Form ,   Notice of Partication Screen Shot ,   Notice of Participation ,   Vendor Authorization Screen Shot ,   Vendor Authorization ,   Withdrawal of Participation

---

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	596,200	471,811	0	124,389	0	0
Annual Time Burden (Hours)	2,279,200	1,415,433	0	863,767	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: No

Burden Reduction Due to:

Short Statement: 1,900 IPFs that fall under the program. This has been changed in the information under section 12 from 1,741 IPFs. Also, this program has increased the number of measures included in its data collection requirements. The CMS program reduces the reporting burden for quality of care information collected by allowing hospitals to abstract data directly into electronic systems in lieu of submitting paper charts, or to utilize electronic data that they already report to the Joint Commission (JCO) for accreditation. The long-term vision for the IPFQR program is to allow hospitals to submit data directly from their electronic health records, which we anticipate will reduce burden substantially.

---

Annual Cost to Federal Government: $41,600

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

---

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: 10/30/2013

---