(CMS-10622) Evaluation of the CMS Quality Improvement Organizations: Reducing Healthcare-Acquired Conditions in Nursing Homes

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10622 QIN-QIO Interview	Form and Instruction	New	Available
Form CMS-10622 QIN-QIO Focus Group Guide	Form and Instruction	New	Available
Form CMS-10622 Peer Coach Interview	Form and Instruction	New	Available
Form CMS-10622 Nursing Home Interview	Form and Instruction	New	Available
Form CMS-10622 Nursing Home Survey Instrument	Form and Instruction	New	Available
CMS-10622_Response_to_Public_Comments_110416.doc	Supplementary Document	Uploaded 2016-11-14	Available
CMS-10622_Sup_Statement_Part_B - Passback3_Response_042517_clean.docx	Supporting Statement B	Uploaded 2017-05-24	Available
CMS-10622_Sup_Statement_Part_A - Passback_Response_030917_clean.docx	Supporting Statement A	Uploaded 2017-05-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
224413	Evaluation of the CMS Quality Improvement Organizations: Reducing Healthcare-Acquired Conditions in Nursing Homes	Form and Instruction	New	QIN-QIO Interview
224413	Evaluation of the CMS Quality Improvement Organizations: Reducing Healthcare-Acquired Conditions in Nursing Homes	Form and Instruction	New	QIN-QIO Focus Group Guide
224413	Evaluation of the CMS Quality Improvement Organizations: Reducing Healthcare-Acquired Conditions in Nursing Homes	Form and Instruction	New	Peer Coach Interview
224413	Evaluation of the CMS Quality Improvement Organizations: Reducing Healthcare-Acquired Conditions in Nursing Homes	Form and Instruction	New	Nursing Home Interview
224413	Evaluation of the CMS Quality Improvement Organizations: Reducing Healthcare-Acquired Conditions in Nursing Homes	Form and Instruction	New	Nursing Home Survey Instrument

ICR Details

OMB Control No: 0938-1330	ICR Reference No: 201611-0938-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: (CMS-10622) Evaluation of the CMS Quality Improvement Organizations: Reducing Healthcare-Acquired Conditions in Nursing Homes
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 with change	Conclusion Date: 06/08/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/15/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved
Responses	856	0	0
Time Burden (Hours)	255	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: As required by Sections 1152-1154 of the Social Security Act, CMS directs the QIO Program, one of the largest federal programs dedicated to improving health quality for Medicare beneficiaries. QIOs help Medicare providers with quality improvement throughout the spectrum of care and to review quality concerns for the protection of beneficiaries and the Medicare Trust Fund. This program is a key component of the U.S. Department of Health and Human Services' (HHS) National Quality Strategy and the CMS Quality Strategy, with the overarching goals to achieve better health care, better health and lower costs of care.

---

Authorizing Statute(s): US Code: 42 USC 1153; 1320C-2 Name of Law: Contracts with QIOs
   PL: Pub.L. 112 - 40 261 Name of Law: Improvements to Contracts with Medicare Quality Improvement Organizations (QIOs) in order to improve
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 42710	06/30/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 75409	10/31/2016
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Evaluation of the CMS Quality Improvement Organizations: Reducing Healthcare-Acquired Conditions in Nursing Homes	CMS-10622, CMS-10622, CMS-10622, CMS-10622, CMS-10622	Nursing Home Survey Instrument ,   Nursing Home Interview ,   Peer Coach Interview ,   QIN-QIO Focus Group Guide ,   QIN-QIO Interview

---

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	856	0	0	856	0	0
Annual Time Burden (Hours)	255	0	0	255	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: This is a new information collection.

---

Annual Cost to Federal Government: $316,848

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: 11/15/2016

---