Hospital Reporting Initiative--Hospital Quality Measures

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10210 Reconsideration Request Form	Form and Instruction	Unchanged	Available
Form CMS-10210 HIQR Notice of Participation Form	Form and Instruction	Unchanged	Available
Form CMS-10210 HVBP Review and Correction Rquest Form Screen Shot	Form and Instruction	Unchanged	Repair queued
Form CMS-10210 HVBP Appeal Request Form Screen Shot	Form and Instruction	Unchanged	Repair queued
Form CMS-10210 Healthcare Associated Infection Exception Form	Form and Instruction	Unchanged	Available
Form CMS-10210 Extroadinary Circumstances Disaster Waiver	Form and Instruction	Unchanged	Available
Form CMS-10210 Reconsideration Request Form electronic	Form and Instruction	Unchanged	Available
Form CMS-10210 Request for Withholding Data from Public Reporting	Form and Instruction	Unchanged	Available
Form CMS-10210 Validation Template CDI	Form and Instruction	Unchanged	Repair queued
Form CMS-10210 Validation Template CLABSI	Form and Instruction	Unchanged	Available
Form CMS-10210 Validation Template MRSA	Form and Instruction	Unchanged	Repair queued
Form CMS-10210 Validation Template CAUTI	Form and Instruction	Unchanged	Available
Form CMS-10210 HVBP Appeal Request Form	Form and Instruction	Unchanged	Available
Form CMS-10210 HVBP Review and Corrections Form	Form and Instruction	Unchanged	Available
Form CMS-10210 Data Accuracy and Completeness Acknowledgemenmt	Form and Instruction	Unchanged	Available
CMS-10210 Hospital Inpatient Quality Reporting Supporting Statement A (2).docx	Supporting Statement A	Uploaded 2015-04-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	Reconsideration Request Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	HIQR Notice of Participation Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	HVBP Review and Correction Rquest Form Screen Shot
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	HVBP Appeal Request Form Screen Shot
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	Healthcare Associated Infection Exception Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	Extroadinary Circumstances Disaster Waiver
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	Reconsideration Request Form electronic
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	Request for Withholding Data from Public Reporting
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	Validation Template CDI
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	Validation Template CLABSI
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	Validation Template MRSA
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	Validation Template CAUTI
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	HVBP Appeal Request Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	HVBP Review and Corrections Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Unchanged	Data Accuracy and Completeness Acknowledgemenmt

ICR Details

OMB Control No: 0938-1022	ICR Reference No: 201504-0938-002
Status: Historical Active	Previous ICR Reference No: 201402-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No: 21471
Title: Hospital Reporting Initiative--Hospital Quality Measures
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: 05/29/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/02/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved	03/31/2016
Responses	17,600	0	17,600
Time Burden (Hours)	6,050,000	0	6,750,000
Cost Burden (Dollars)	0	0	0

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Abstract: The Hospital Inpatient Quality Reporting Program (IQR) program was first established to implement section 5001(b) of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) (Pub. L. 108-173), which authorized CMS to pay hospitals that successfully reported quality measures a higher annual update to their payment rates. It builds on a voluntary Inpatient Quality Reporting program which remains in effect. The Hospital IQR program formerly known as the Reporting Hospital Quality Data for Annual Payment Update program, began with an initial set of 10 measures. Section 5001(a) of the Deficit Reduction Act of 2005 (DRA) (Pub. L. 109-171) revised the mechanism used to update the standardized amount for payment for hospital inpatient operating costs. This is reflected in Sections 1886(b)(3)(B)(viii)(I) and (II) of the Social Security Act which provide that the annual payment update (APU) will be reduced for any "subsection (d) hospital" that does not submit certain quality data in a form and manner, and at a time, specified by the Secretary. Section 5001(a) of the DRA also expanded the scope of IQR, requiring CMS to add new measures. Sections 1886(b)(3)(B)(viii)(III) through (V) of the Social Security Act, required CMS to "adopt the baseline set of performance measures as set forth in the November 2005 report by the Institute of Medicine of the National Academy of Sciences", instructed the Secretary to "add other measures that reflect consensus among affected parties", and allowed the Secretary to "replace any measures or indicators in appropriate cases". When adding new measures, the law required CMS when "feasible and practical" to select measures put forward by "one or more national consensus building entities".

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Authorizing Statute(s): PL: Pub.L. 108 - 173 5001(b) Name of Law: Medicare Prescription Drug, Improvement and Modernization Act of 2003
   PL: Pub.L. 111 - 148 3001 Name of Law: Affordable Care Act
   PL: Pub.L. 109 - 171 5001(a) Name of Law: Hospital Quality Improvement
  

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	78 FR 50496	08/19/2013

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Federal Register Notices & Comments

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
Quality Measures and Procedures for Hospital Reporting of Quality Data	CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210	Data Accuracy and Completeness Acknowledgemenmt ,   HVBP Review and Corrections Form ,   HVBP Appeal Request Form ,   Validation Template CAUTI ,   Validation Template MRSA ,   Validation Template CLABSI ,   Validation Template CDI ,   Request for Withholding Data from Public Reporting ,   Reconsideration Request Form electronic ,   Extroadinary Circumstances Disaster Waiver ,   Healthcare Associated Infection Exception Form ,   HVBP Appeal Request Form Screen Shot ,   HVBP Review and Correction Rquest Form Screen Shot ,   HIQR Notice of Participation Form ,   Reconsideration Request 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	17,600	17,600	0	0	0	0
Annual Time Burden (Hours)	6,050,000	6,750,000	0	-700,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: CMS 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 utlize electronic data that they already report to JCO for accreditation.

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Annual Cost to Federal Government: $9,550,000

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: 04/02/2015

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