CAHPS Home Health Care Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10275 HHCAHPS Participation Exemption Request (PER) Form	Form	New	Repair queued
Form CMS-10275 CAHPS Home Health Care Survey (CMS-10275)	Form	Modified	Available
HomeHealthCAHPS_OMB_PartB revised 6-10-13.doc	Supporting Statement B	Uploaded 2014-01-24	Available
HHCAHPS_LeadLetter2_English.pdf	Supplementary Document	Uploaded 2014-01-24	Available
HHCAHPS_LeadLetter1_English.pdf	Supplementary Document	Uploaded 2014-01-24	Repair queued
CMS-10275 - Supporting Statement A [rev 1-23-2014].doc	Supporting Statement A	Uploaded 2014-01-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210204	HHCAHPS Participation Exemption Request (PER) Form	Form	New
195477	Patient Assessment		Modified
188901	CAHPS Home Health Care Survey (CMS-10275)	Form	Modified

ICR Details

OMB Control No: 0938-1066	ICR Reference No: 201401-0938-015
Status: Historical Active	Previous ICR Reference No: 201011-0938-018
Agency/Subagency: HHS/CMS	Agency Tracking No: 21347
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: Approved without change	Conclusion Date: 05/16/2014
	Date Received in OIRA: 01/29/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2017	36 Months From Approved	05/31/2014
Responses	2,978,890	0	2,715,890
Time Burden (Hours)	752,800	0	699,440
Cost Burden (Dollars)	0	0	39,560,000

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Abstract: 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. This is a revised PRA package because it now includes the burden to the home health agencies (HHAs) to contract with an approved HHCAHPS survey vendor to administer the HHCAHPS survey on their behalf.

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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	Final or interim final rulemaking	78 FR 72256	12/02/2013

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 40271	07/03/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 72256	12/02/2013
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
CAHPS Home Health Care Survey (CMS-10275)	CMS-10275, CMS-10275, CMS-10275, CMS-10275, CMS-10275	Home Health Care CAHPS Survey (English) ,   Home Health Care CAHPS Survey (Russian) ,   Home Health Care CAHPS Survey (Spanish) ,   Home Health Care CAHPS Survey (Telephone) ,   Home Health Care CAHPS Survey (Telephone/Proxy)
Patient Assessment
HHCAHPS Participation Exemption Request (PER) Form	CMS-10275	Participation Exemption Request (PER) 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	2,978,890	2,715,890	0	0	261,000	2,000
Annual Time Burden (Hours)	752,800	699,440	0	0	52,200	1,160
Annual Cost Burden (Dollars)	0	39,560,000	0	0	-39,560,000	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: The number of individuals completing the survey has been adjusted from 2,706,000 to 2,967,000. The program change 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. 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.

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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: 01/29/2014

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