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

Forms and Documents

Document Name	Status
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	Modified
CMS-10569 ESRD QIP Supporting Statement A_OMB.2.24.2016 CLEAN.DOCX Supporting Statement A	2016-02-24

IC Document Collections

IC ID	Document Title	Status
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	Modified

ICR Details

OMB Control No: 0938-1289	ICR Reference No: 201511-0938-003
Status: Historical Active	Previous ICR Reference No: 201507-0938-011
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: Approved without change	Conclusion Date: 02/24/2016
	Date Received in OIRA: 11/12/2015
Terms of Clearance: Approved consistent with the understanding that Agency will display the OMB Control Number and Expiration Date on all information collection materials.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	36 Months From Approved
Responses	773,737	0	0
Time Burden (Hours)	844,921	0	0
Cost Burden (Dollars)	0	0	0

---

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.

---

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

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS48	Final or interim final rulemaking	80 FR 68967	11/06/2015

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

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	HD Clinical Page ,   PD Clinical Page ,   Clinical Depression Screenshot ,   Pain Assessment Screenshot

---

ICR Summary 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	773,737	0	0	773,737	0	0
Annual Time Burden (Hours)	844,921	0	0	844,921	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: In the previous version of this package, we included two proposed reporting measures (the Ultrafiltration Rate reporting measure and the Full-Season Influenza Vaccination reporting measure) in the CY 2017 burden estimates. CMS did not finalize the adoption of these measures.

---

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

---

Common Form ICR:  No

---

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: 11/12/2015

---