PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10431 Notice of Participation form	Form and Instruction	Modified	Available
Form CMS-10431 Measure Exception Form	Form and Instruction	Modified	Available
Form CMS-10431 Data Accuracy and Completeness Acknowledgement	Form and Instruction	Modified	Available
Form CMS-10431 SCIP Pop Sample Application	Form and Instruction	Modified	Available
Form CMS-10431 SCIP Pop Sample paper based	Form and Instruction	Modified	Available
Form CMS-10431 OCM Pop Sample paper based	Form and Instruction	Modified	Available
Form CMS-10431 Oncology Care Measures Pop Sample application	Form and Instruction	Modified	Available
Form CMS-10431 EBRT web application	Form and Instruction	Modified	Available
Form CMS-10431 EBRT Pop Sample paper based	Form and Instruction	Modified	Available
Form CMS-10431 EBRT Paper based	Form and Instruction	Modified	Available
Form CMS-10431 EBRT Pop Sample Application	Form and Instruction	Modified	Available
Form CMS-10431 SCIP Measures Paper Submission	Form and Instruction	Modified	Available
Form CMS-10431 Oncology Care Measures Paper Submission	Form and Instruction	Modified	Available
PCHQR Burden Estimate_7 24 2014.docx	Supplementary Document	Uploaded 2014-08-20	Available
PCHQR PRA_Appendix B.July_24_2014.docx	Supplementary Document	Uploaded 2014-08-20	Available
PCHQR PRA_Appendix A Aug_4_2014.V2 (1).docx	Supplementary Document	Uploaded 2014-08-20	Available
COMPARE - PCHQR Supporting Statement Part A_v2 (8-4-14).docx	Supplementary Document	Uploaded 2014-08-20	Available
PCHQR PRA_Appendix B July_24_2014.docx	Supplementary Document	Uploaded 2014-08-20	Available
FY 2016 and FY 2017 _Supporting Statement A PRA _PCHQR Aug_14_2014.Final.docx	Supporting Statement A	Uploaded 2014-08-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	Notice of Participation form
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	Measure Exception Form
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	Data Accuracy and Completeness Acknowledgement
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	SCIP Pop Sample Application
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	SCIP Pop Sample paper based
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	OCM Pop Sample paper based
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	Oncology Care Measures Pop Sample application
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	EBRT web application
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	EBRT Pop Sample paper based
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	EBRT Paper based
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	EBRT Pop Sample Application
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	SCIP Measures Paper Submission
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	Form and Instruction	Modified	Oncology Care Measures Paper Submission

ICR Details

OMB Control No: 0938-1175	ICR Reference No: 201401-0938-010
Status: Historical Active	Previous ICR Reference No: 201209-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: 21324
Title: PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/26/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/15/2014
Terms of Clearance: OMB is approving this information collection request for a period of two years during which time CMS will request approval to extend or revise the collection if the Agency seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2016	24 Months From Approved	12/31/2015
Responses	413,556	0	27,273
Time Burden (Hours)	206,891	0	68,182
Cost Burden (Dollars)	0	0	0

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Abstract: Section 3005 of the Affordable Care Act authorizes the establishment of a quality reporting program for PPS-exempt cancer hospitals (PCHs). Beginning in FY 2017 and subsequent fiscal years, it is proposed that PCHs will be required to collect and submit 19 quality measures to CMS (18 of these were previously reported under this program, and one is new). Measures are added to the PCH Quality Reporting (PCHQR) Program in order to ensure a measure set that reflects the appropriate level of care and the most important areas of service furnished by PCHs. Measure data are intended to be publicly reported. CMS is also proposing to collect population and sampling data stratified by Medicare and non-Medicare data for the 5 clinical process/oncology care measures.

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Authorizing Statute(s): PL: Pub.L. 111 - 48 3005 Name of Law: 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-AR53	Final or interim final rulemaking	79 FR 44128	07/29/2014

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 27485	05/10/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 44128	07/29/2014
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
PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431	Oncology Care Measures Paper Submission ,   SCIP Measures Paper Submission ,   EBRT Pop Sample Application ,   EBRT Paper based ,   EBRT Pop Sample paper based ,   EBRT web application ,   Oncology Care Measures Pop Sample application ,   OCM Pop Sample paper based ,   SCIP Pop Sample paper based ,   SCIP Pop Sample Application ,   Data Accuracy and Completeness Acknowledgement ,   Measure Exception Form ,   Notice of Participation form

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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	413,556	27,273	0	386,283	0	0
Annual Time Burden (Hours)	206,891	68,182	0	138,709	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: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This program has increased the number of measures included in its data collection requirements, from 18 quality measures to 19 quality measures, based on policies included in the FY 2015 IPPS/LTCH final rule. However, the overall burden estimate has decreased by 364,433 hours due to the consideration of sampling methodologies which allow PCHs to report fewer than the full population size for the SCIP, OCM, EBRT, and the HCAHPS survey.

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Annual Cost to Federal Government: $83,200

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: 01/15/2014

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