Attachment II - Data Sources Used for 2015 Impact Assessment

Attachment II: Data Sources Used for 2015 Impact Assessment Report

Data used in 2015 Impact Assessment Report	Year / Time Period	OMB Title	OMB Control Number
Acute Myocardial Infarction (AMI) Annual Readmission and Mortality Rates	2007 - 2012	Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) (6/12/2008 - 6/30/2011) Hospital Reporting Initiative--Hospital Quality Measures (9/18/2012)	0938-1022
American Hospital Association (AHA) Survey	2008 & 2012		No number, not federal. purchased non-federal data
Chronic Conditions Data Warehouse (CCW) Master Beneficiary Summary File (MBSF) (Part A)	2006 - 2012	Inpatient Claims	0938-0279 0938-0997
Chronic Conditions Data Warehouse (CCW) Master Beneficiary Summary File (MBSF) (Part B)	2006 - 2012	Physician /Non-Institutional Claims	0938-0999
Chronic Conditions Data Warehouse (CCW) Master Beneficiary Summary File (MBSF) (Part D)	2006 - 2012	Collection of Drug Event Data from Contracted Part D Providers For Payments	0938-0982
Chronic Conditions Data Warehouse (CCW) Master Beneficiary Summary File (MBSF)	2006 - 2012	Medicare Enrollment Data	0938-0685
CMS Abstraction and Reporting Tool (CART) - Inpatient and Outpatient	2004 - 2012	Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures)	0938-1022
CMS Denominator	2004 - 2012	Medicare Enrollment Application (Form 855S)	0938-1056
Health Care Information System (HCIS)	2006-2012	Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5	0938-0997
Health Outcomes Survey Data	2008 - 2011	Medicare Health Outcomes Survey (HOS) and Supporting Regulations at 42 CFR 422.152	0938-0701
Heart Failure (HF) Annual Mortality & Readmission Rates	2009 - 2012	Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) (6/12/2008 - 6/30/2011) Hospital Reporting Initiative--Hospital Quality Measures (9/18/2012)	0938-1022
HEDIS Information Collection Request (CMS-10219)	2007 - 2012	Healthcare Effectiveness Data and Information Set (HEDIS) Data Collection for Medicare Advantage	0938-1028
Hierarchical Condition Category Files (HCC)	2005 - 2012	Collection of Diagnostic Data from Medicare+Choice Organizations for Risk Adjusted Payment Supporting Regulations CFR Part 422 Subpart F & G	0938-0878
Hospital Outpatient Prospective Payment System (OPPS)	Jan 08 - Jun 08	Submission of Information for the Hospital Outpatient Quality Data Program	0938-1044
Hospital Outpatient Prospective Payment System (OPPS)	2009 - 2012	(CMS-R-240) Prospective Payments for Hospital Outpatient Services and Supporting Regulations in 42 CFR 413.24, 413.65 (6/6/2007 - 10/31/2010)(CMS-R-240) Prospective Payments for Hospital Outpatient Services and Supporting Regulations in 42 CFR 413.65 Type of Information Collection: Revision of a currently approved collection Common Form ICR: No (10/29/2010 - 2/28/2014)	0938-0798
Minimum Data Set (MDS) 3.0	2010 - 2012	Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2012 - Change of Therapy OMRA	0938-1140
Minimum Data Set (MDS) 2.0	2003 - 2010	MPAF Data and Supporting Regulations in 42 CFR Sections 413.337, 413.343, 424.32 and 483.20	0938-0739
Outcome and Assessment Information Set (OASIS)-B	2006 - 2009	Medicare and Medicaid Programs OASIS Collection Requirements as Part of the CoPs for HHAs and Supp. Regs. in 42 CFR 484.55, 484.205, 484.245, 484.250	0938-0760
Outcome and Assessment Information Set (OASIS)-C	2008 - 2012	Medicare and Medicaid Programs OASIS Collection Requirements as Part of the CoPs for HHAs and Supp. Regs. in 42 CFR 484.55, 484.205, 484.245, 484.250	0938-0760
Part A - Inpatient Claims	2006 - 2007	Medicare Uniform Institutional Provider Bill	0938-0279
Part A - Inpatient Claims	2008 - 2012	Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5	0938-0997
Part A - Outpatient Claims	2008 - 2012	CMS-R-240) Prospective Payments for Hospital Outpatient Services and Supporting Regulations in 42 CFR 413.65	0938-0798 0938-0279 0938-0997
Part B - Carrier Claims (Non-institutional claims)	2006 - 2012	Insurance Common Claims Form and Supporting Regulations at 42 CFR Part 424 Subpart C	0938-0999
Part D Events (PDE)	2007 - 2012	Collection of Prescription Drug Data from MA-PD, PDP and Fallout Plans/Sponsors for Medicare Part D Payments	0938-0982
Part D Measure Data	2008 - 2012	Medicare Part D Reporting Requirements under 42 CFR section 423.505	0938-0992
Physician Quality Reporting System (PQRS) files	2007-2008	Existing collection in use without an OMB Control Number	N/A
Physician Quality Reporting System (PQRS) files	2009 - 2011	Physician Quality Reporting Initiative	0938-1059
Pneumonia (PNE) Annual Readmission & Mortality Rates	2009 - 2012	Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (Surgical Care Improvement Project & Mortality Measures) (6/12/2008 - 6/30/2011) Hospital Reporting Initiative--Hospital Quality Measures (9/18/2012)	0938-1022
The Medicare Managed Care CAHPS Survey : CMS-R-246	2006 - 2013	The Medicare Managed Care CAHPS Survey and Supporting Regulations in 42 CFR 417.126 and 417.470	0938-0732

Confidential Material: This material has not been publicly disclosed - Internal Government Use Only Page 2