Hospice Quality Reporting Program

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
HIS Public Comments & Responses. 08.14.13.docx	Supplementary Document	Uploaded 2014-03-25	Available
Changes to Hospice Item Set 12 4 13.pdf	Supplementary Document	Uploaded 2014-03-25	Available
Hospice PRA Burden Estimate 08 23 13.docx	Supplementary Document	Uploaded 2014-03-25	Available
Revised Supporting Statement A 09 17 13.clean copy.docx	Supporting Statement A	Uploaded 2014-03-25	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: 201403-0938-016
Status: Historical Active	Previous ICR Reference No: 201208-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: 21627
Title: Hospice Quality Reporting Program
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/03/2014
	Date Received in OIRA: 03/28/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2017	36 Months From Approved
Responses	3,742	0	0
Time Burden (Hours)	525,827	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: Section 3004(c) of the Patient Protection and Affordable Care Act (ACA), (which added section 1814(i)(5) to the Social Security Act) ), authorized the Secretary to establish a quality reporting program for hospices. Section 1814(i)(5)(A)(i) of the Social Security Act required 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. 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 National Quality Forum (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. Hospices will continue to collect data for these measures until December 31, 2013. Beginning on July, 1, 2014, hospices shall begin to collect quality measure data using a newly created set of data elements which are collectively titled as the "Hospice Item Set." The Hospice Item Set, which was developed specifically for use in the hospice setting, contains data elements that are used to collect standardized, patient-level data. This data can be used, at a later date, to calculate six NQF-endorsed quality measures and a modification of one NQF-endorsed measure. For more details about the Hospice Item Set, refer to Section 1 of the Supporting Statement A.

---

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

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AR64	Final or interim final rulemaking	78 FR 48233	08/07/2013

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

---

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	Hospice Item Set - Discharge ,   Hospice Item Set - Descriptions ,   Hospice Item Set - Admissions

---

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	3,742	0	0	110	0	3,632
Annual Time Burden (Hours)	525,827	0	0	-131,565	0	657,392
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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The first reporting period in which the new Hospice Item Set will be implemented will begin on July, 1, 2014 and end on December 31, 2014. This Hospice Item Set will be used in each 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.

---

Annual Cost to Federal Government: $1,583,500

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: 03/28/2014

---