Hospital Outpatient Quality Data Program (HOPQDRP) (CMS-10250)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10250 Reconsideration Request Form	Form and Instruction	Modified	Available
Form CMS-10250 Validation Review for Reconsideration Request	Form and Instruction	Modified	Available
Form CMS-10250 Notice of Participation Form	Form and Instruction	Modified	Available
Form CMS-10250 Extroadinary Circumstances Form	Form and Instruction	Modified	Available
Form CMS-10250 Notice of Participation	Form and Instruction	Removed	Available
Form CMS-10250 Notice of Participation	Form and Instruction	Removed	Available
Form CMS-10250 Notice of Participation	Form and Instruction	Removed	Available
Form CMS-10250 Extroadinary Circumstances	Form and Instruction	Removed	Available
Form CMS-10250 Request for Reconsideration Part 2	Form and Instruction	Removed	Available
Form CMS-10250 Request for Reconsideration Part 1	Form and Instruction	Removed	Available
CMS-10250 Supporting Statement Part B CY 2016 OPPS-ASC Final Rule-Hospit....doc	Supporting Statement B	Uploaded 2016-06-23	Available
CMS-10250 Supporting Statement Part A CY 2016 OPPS-ASC Final Rule-Hospit....doc	Supporting Statement A	Uploaded 2016-06-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
217995	Hospital Outpatient Quality Reporting CY 2016 - CY 2018	Form and Instruction	Modified	Reconsideration Request Form
217995	Hospital Outpatient Quality Reporting CY 2016 - CY 2018	Form and Instruction	Modified	Validation Review for Reconsideration Request
217995	Hospital Outpatient Quality Reporting CY 2016 - CY 2018	Form and Instruction	Modified	Notice of Participation Form
217995	Hospital Outpatient Quality Reporting CY 2016 - CY 2018	Form and Instruction	Modified	Extroadinary Circumstances Form
213183	Hospital Outpatient Quality Data Program -Web based OP-31 (CY 2017)		Removed
213179	Hospital Outpatient Quality Data Program - Administrative (CY 2017)		Removed
213175	Hospital Outpatiennt Quality Data Program - Data Validation (CY 2017)		Removed
213174	Hospital Outpatient Quality Data Program - Notice of Participation Web based (CY 2017)		Removed
213170	Hospital Outpatient Quality Data Program -- Data Abstration (CY 2017)		Removed
209862	Hospital Outpatient Quality Data Program - Data Validation (CY 2016)		Removed
209861	Hospital Outpatient Quality Program - Notice of Participation (CY 2016)	Form and Instruction	Removed	Notice of Participation
209860	Hospital Outpatient Quality Data Program - Data Abstration (CY 2016)		Removed
209859	Hospital Outpatient Quality Data Program - Data Validation (CY 2015)		Removed
209858	Hospital Outpatient Quality Data Program - Notice of Participation (CY 2015)	Form and Instruction	Removed	Notice of Participation
209857	Hospital Outpatient Quality Data Program - Data Abstraction (CY 2015)		Removed
209856	Hospital Outpatient Quality Data Program - Data Validation (CY 2014)		Removed
209855	Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014)	Form and Instruction	Removed	Notice of Participation
209855	Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014)	Form and Instruction	Removed	Extroadinary Circumstances
209855	Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014)	Form and Instruction	Removed	Request for Reconsideration Part 2
209855	Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014)	Form and Instruction	Removed	Request for Reconsideration Part 1
209854	Hospital Outpatient Quality Data Program - Data Abstraction (CY 2014)		Removed

ICR Details

OMB Control No: 0938-1109	ICR Reference No: 201603-0938-010
Status: Historical Active	Previous ICR Reference No: 201508-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: 21225
Title: Hospital Outpatient Quality Data Program (HOPQDRP) (CMS-10250)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/27/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/16/2016
Terms of Clearance: The agency is required to display the OMB Control Number and inform respondents of its legal significance in accordance with 5 CFR 1320.5(b).

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	36 Months From Approved	01/31/2017
Responses	2,331,486	0	5,115,060
Time Burden (Hours)	3,056,717	0	6,060,452
Cost Burden (Dollars)	0	0	0

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Abstract: Section 109(a) of the Tax Relief and Health Care Act of 2006 (TRHCA) (Pub. L. 109-432) amended section 1833(t) of the Social Security Act by adding a new subsection (17) that affects the payment rate update applicable to Outpatient Prospective Payment System (OPPS) payments for services furnished by hospitals in outpatient settings on or after January 1, 2009. Section 1833(t)(17)(A) of the Act, which applies to hospitals as defined under section 1886(d)(1)(B) of the Act, requires that hospitals that fail to report data required for quality measures selected by the Secretary in the form and manner required by the Secretary under section 1833(t)(17)(B) of the Act will incur a reduction in their annual payment update (APU) factor to the hospital outpatient department fee schedule by 2.0 percentage points. Hospital OQR Program payment determinations are made based on Hospital OQR Program quality measure data reported and supporting forms submitted by hospitals as specified through rulemaking. To reduce burden, a variety of different data collection mechanisms are employed, with every consideration taken to employ existing data and data collection systems.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3014 Name of Law: Affordable Care Act
   PL: Pub.L. 109 - 432 109(a) Name of Law: Quality reporting for hospital outpatient services and ambulatory surgical center services
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS42	Final or interim final rulemaking	80 FR 70298	11/13/2015

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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
Hospital Outpatiennt Quality Data Program - Data Validation (CY 2017)
Hospital Outpatient Quality Data Program - Administrative (CY 2017)
Hospital Outpatient Quality Data Program - Data Abstraction (CY 2014)
Hospital Outpatient Quality Data Program - Data Abstraction (CY 2015)
Hospital Outpatient Quality Data Program - Data Abstration (CY 2016)
Hospital Outpatient Quality Data Program - Data Validation (CY 2014)
Hospital Outpatient Quality Data Program - Data Validation (CY 2015)
Hospital Outpatient Quality Data Program - Data Validation (CY 2016)
Hospital Outpatient Quality Data Program - Notice of Participation (CY 2014)	CMS-10250, CMS-10250, CMS-10250, CMS-10250	Request for Reconsideration Part 1 ,   Request for Reconsideration Part 2 ,   Extroadinary Circumstances ,   Notice of Participation
Hospital Outpatient Quality Data Program - Notice of Participation (CY 2015)	CMS-10250	Notice of Participation
Hospital Outpatient Quality Data Program - Notice of Participation Web based (CY 2017)
Hospital Outpatient Quality Data Program -- Data Abstration (CY 2017)
Hospital Outpatient Quality Data Program -Web based OP-31 (CY 2017)
Hospital Outpatient Quality Program - Notice of Participation (CY 2016)	CMS-10250	Notice of Participation
Hospital Outpatient Quality Reporting CY 2016 - CY 2018	CMS-10250, CMS-10250, CMS-10250, CMS-10250	Extroadinary Circumstances Form ,   Notice of Participation Form ,   Validation Review for Reconsideration Request ,   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	2,331,486	5,115,060	0	-2,783,574	0	0
Annual Time Burden (Hours)	3,056,717	6,060,452	0	-3,003,735	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The program has increased the number of measures included in its data collection requirements. Therefore, there is a net increase in burden.

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Annual Cost to Federal Government: $11,500,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 03/16/2016

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