(CMS-10569) Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10569 : End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network	Form and Instruction	New	Available
CMS-10569 ESRD QIP Supporting Statement A.docx	Supporting Statement A	Uploaded 2015-07-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
217583	: End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network	Form and Instruction	New

ICR Details

OMB Control No: 0938-1289	ICR Reference No: 201507-0938-011
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: (CMS-10569) Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb)
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: 10/29/2015
	Date Received in OIRA: 07/21/2015
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: Section 1881(h) of the Social Security Act, as amended by section 153(h) of the Medicare Improvements for Patients and Providers Act, authorizes the establishment of a quality incentive program for renal dialysis facilities. Beginning in CY 2016, renal dialysis facilities will be required to collect and submit data on four quality reporting measures to CMS using Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb); in CY 2017, this will be increased to six quality reporting measures. Measures are added to the ESRD Quality Incentive Program in order to ensure a measure set that reflects the appropriate level of care and the most important areas of service furnished by renal dialysis facilities. Measure data are intended to be publicly reported.

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Authorizing Statute(s): US Code: 42 USC 1395 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: US Code: 42 USC 1395; section 1881 Name of Law: Social Security Act

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS48	Proposed rulemaking	80 FR 37807	07/01/2015

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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
: End-Stage Renal Disease Quality Incentive Program: Data Collection for Quality Measures Using the Consolidated Renal Operations in a Web-Enabled Network	CMS-10569, CMS-10569, CMS-10569, CMS-10569	Pain Assessment Screenshot ,   HD Clinical Page ,   PD Clinical Page ,   Clinical Depression Screenshot

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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: The ESRD QIP has consistently expanded its measure set since the inception of the ESRD QIP in CY 2011, and is now proposing to add two new reporting measures beginning in CY 2017. These proposed additions to the ESRD QIP are expected to result in an increased burden to renal dialysis facilities. These added measures support the ESRD QIP's mission of ensuring that ESRD patients receive high-quality care from their renal dialysis facilities by ensuring that the facilities are diligent in monitoring crucial aspects of ESRD patients' care.

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Annual Cost to Federal Government: $2,319,968

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: 07/21/2015

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