(CMS-10539) Medicare and Medicaid Programs: Conditions of Participation for Home Health Agencies (HHA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CMS-10539 Supporting Statement - Updated 07-09-15.pdf	Supporting Statement A	Uploaded 2015-07-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
217414	484.110(a) - content of clinical records		New
217412	484.105(h)		New
217411	484.105(h) - existing		New
217410	484.100(a) - new agencies		New
217409	484.100(a) - existing		New
217408	484.80(d) - in-service training		New
217407	484.80(b) - home health aide classroom and practical training		New
217406	484.80(c) - compentency evaluation		New
217404	484.80(a)		New
217403	484.65(e) - quality assessment and performance		New
217401	484.60(a) care planning		New
217400	484.50(e)		New
217398	484.50(a) existing agencies		New
217396	484.50(a) new agencies		New

ICR Details

OMB Control No: 0938-1299	ICR Reference No: 201507-0938-005
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: (CMS-10539) Medicare and Medicaid Programs: Conditions of Participation for Home Health Agencies (HHA)
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: Comment filed on proposed rule	Conclusion Date: 02/24/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/10/2015
Terms of Clearance: OMB is withholding approval at this time. Prior to publication of the final rule, the agency should provide a summary of any comments related to the information collection and their response, including any changes made to the ICR as a result of comments. In addition, the agency must enter the correct burden estimates.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Home health agencies are required to maintain certain documentation within their own agency records that demonstrates compliance with specific Conditions of Participation for the Medicare program. This documentation is maintained on-site for use in the home health agency survey process.

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Authorizing Statute(s): PL: Pub.L. 101 - 239 6005(b) Name of Law: Omnibus Reconciliation Act of 1989
   US Code: 42 USC 1395X Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AG81	Proposed rulemaking	79 FR 61163	10/09/2014

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 23006	04/24/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 38207	07/02/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 14

table that charts list of burden

IC Title	Form No.	Form Name
484.100(a) - existing
484.100(a) - new agencies
484.105(h)
484.105(h) - existing
484.110(a) - content of clinical records
484.50(a) existing agencies
484.50(a) new agencies
484.50(e)
484.60(a) care planning
484.65(e) - quality assessment and performance
484.80(a)
484.80(b) - home health aide classroom and practical training
484.80(c) - compentency evaluation
484.80(d) - in-service training

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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: $0

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]? 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: 07/10/2015

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