Hospice Quality Reporting Program: Program Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10504 Hospice QRP Program Evaluation	Form and Instruction	New	Available
CMS-10504 Supporting Statement B Hospice Program.docx	Supporting Statement B	Uploaded 2014-06-17	Available
Burden Estimate. Hospice Monitoring PRA. 09.06.13.docx	Supplementary Document	Uploaded 2014-03-18	Available
CMS-10504 Supporting Statement A Hospice Program.docx	Supporting Statement A	Uploaded 2014-06-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
211030	Hospice QRP Program Evaluation	Form and Instruction	New

ICR Details

OMB Control No: 0938-1243	ICR Reference No: 201403-0938-018
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: 21592
Title: Hospice Quality Reporting Program: Program Evaluation
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/18/2014
	Date Received in OIRA: 03/31/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2015	12 Months From Approved
Responses	30	0	0
Time Burden (Hours)	71	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 3004(c) of the Affordable Care Act, which added Section 1814(i)(5) to the Social Security Act (the Act"), mandated the establishment of a quality reporting program for Hospices. Section 1814 (i)(5)(C) of the Act requires that Hospices submit quality measurement data to CMS in a form and manner, and at a time specified by the Secretary. Section 1814(i)(5)(A)(i) of the Act further requires the Secretary to reduce the market basket percentage increase by two (2%) percentage points for any hospice that fails to submit quality measure data in accordance with requirements established by the Secretary for that fiscal year. Section 1814 (i)(5)(E) of the Act requires the Secretary to establish procedures for making Hospice quality data publically available. The first reporting period began on 10/01/2012 and ended on 12/31/2012. We recently completed a review of the data submitted by hospices during the first reporting to determine which Hospices will receive the 2% payment reduction to the market basket percentage increase for FY 2014. CMS seeks to establish an initial programmatic evaluation of the Hospice QRP in partnership with providers. The information is intended to help inform CMS on how providers are responding to the new QRP, the mechanisms utilized by providers to collect and report data (inclusive of determining the accuracy of that data), burden, practices related to data collection, use of EHRs, etc., and the overall impact and influences of the QRP program on healthcare outcomes. We believe that this program provide an opportunity for CMS to specifically explore how Hospice providers are responding to the Hospice QRP measures, understand early trends in outcomes, and make adjustments as needed to enhance the effectiveness of the program while keeping burden on providers as low as possible. Specifically, we believe such an evaluation will keep CMS to be informed on provider's experience related to the QRP.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3004(c) 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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 70059	11/22/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 13305	03/10/2014
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
Hospice QRP Program Evaluation	CMS-10504	Structured Interview Questions - Hospice

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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	30	0	0	30	0	0
Annual Time Burden (Hours)	71	0	0	71	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: This is a new information collection.

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Annual Cost to Federal Government: $125,000

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]? 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: 03/31/2014

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