Hospice Quality Reporting Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10390 Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	Form and Instruction	Modified	Available
Appendix 1 - Comments and Response CMS-10390.docx	Supplementary Document	Uploaded 2017-03-20	Available
CMS-10390 Exhibit A FY 2017 Hospice PRA Burden Estimate Calculation Worksheet.pdf	Supplementary Document	Uploaded 2017-03-15	Available
CMS-10390 - Hospice Item Set V2 Change Table.pdf	Supplementary Document	Uploaded 2017-03-15	Available
CMS-10390 - Supporting Statement Part A - 33117 Final.docx	Supporting Statement A	Uploaded 2017-03-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
203679	Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1153	ICR Reference No: 201703-0938-011
Status: Historical Active	Previous ICR Reference No: 201403-0938-016
Agency/Subagency: HHS/CMS	Agency Tracking No: 21627
Title: Hospice Quality Reporting Program
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: 04/17/2017
	Date Received in OIRA: 03/20/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved	04/30/2017
Responses	4,259	0	3,742
Time Burden (Hours)	686,631	0	525,827
Cost Burden (Dollars)	0	0	0

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Abstract: Section 3004(c) of the Patient Protection and Affordable Care Act (ACA), (which added section 1814(i)(5) to the Social Security Act) ), authorized the Secretary to establish a quality reporting program for hospices. Section 1814(i)(5)(A)(i) of the Social Security Act required that the Secretary, beginning with FY 2014, reduce the market basket update by 2 percentage points for any hospice that does not submit quality data submission for a fiscal year. During the first "mandatory" reporting period, hospices were required to gather data pertaining to two quality measures: (1) a structural measure titled "Participation in a Quality Assessment and Performance Improvement (QAPI) Program that Includes at Least Three Quality Indicators Related to Patient Care" and; (2) the National Quality Forum (NQF)-endorsed #0209 pain measure. Hospice providers were then required to report their data between 01/01/2012 and 04/01/2012 In the CY 2013 HH PPS final rule (77 FR 67132 through 67136), CMS retained the two measures that had previously been adopted in the FY 2012 rule. Hospices will continue to collect data for these measures until December 31, 2013. Beginning on July, 1, 2014, hospices shall begin to collect quality measure data using a newly created set of data elements which are collectively titled as the "Hospice Item Set." The Hospice Item Set, which was developed specifically for use in the hospice setting, contains data elements that are used to collect standardized, patient-level data. This data can be used, at a later date, to calculate six NQF-endorsed quality measures and a modification of one NQF-endorsed measure. For more details about the Hospice Item Set, refer to Section 1 of the Supporting Statement A.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3004 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS79	Final or interim final rulemaking	81 FR 52143	08/05/2016

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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
Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	CMS-10390, CMS-10390, CMS-10390	Hospice Item Set - Descriptions ,   Hospice Item Set - Admissions ,   Hospice Item Set - Discharge

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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	4,259	3,742	0	0	517	0
Annual Time Burden (Hours)	686,631	525,827	0	0	160,804	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: We estimate the annualized yearly burden per each hospice to be 161 hours, or $9,114.72, and the annualized burden across all hospices to be 686,630 hours, or $38,819,589. We have noted that there will be some increase in burden associated with the use of the HIS V2.00.0. We estimate that the increase to each individual hospice will be approximately 21 hours, or $5,296, and the total increase in burden across all 4,259 hospices will be approximately 160,803 hours, or $24,531,660. (See Exhibit A, Appendix 4). We believe that this increase in burden can be attributed to several factors. First, the burden calculation used in the previous PRA package was based on the use of the HIS v1.00.0. HIS V2.00.0 includes 17 additional items for response: 3 new items in the Admission assessment, and 14 new items in the Discharge assessment. These additional items will be used for: • Data collection for a set of two paired quality measures under development to assess hospice visits when death is imminent • Refinement of quality measure NQF #1637 • Additional administrative items for patient record matching and future public reporting of hospice quality data In addition, the numbers of patients and hospices have increased. We use updated information from the Center for Medicare regarding the current number of Medicare-participating hospices in the U.S. to inform our burden calculations. This figure has increased since the previous PRA submission and thus has increased the burden calculation included in this package. Finally, this burden estimate uses new wage calculations as compared to the HIS V1.00.0 calculations. We have adjusted all wage estimates by a factor of 100 percent to include fringe benefits. Because of this increase in the input wages, the change in cost to hospices appears to be much larger than the change in burden hours. This quality reporting program was mandated by Section 3004(c) of the Affordable Care Act, (1814(i)(5)(A)(i) of the Social Security Act) and therefore, this burden is statutorily mandated: • In order for CMS to meet the requirements set forth in section added by section 3004 (c) of the Patient Protection and Affordable Care Act) which states that the Secretary of the Department of Health and Human Services should establish a quality reporting program for hospices by Fiscal Year 2014. • In order for each hospice to comply with the reporting requirements of ACA Section 3004(c). • In order for each hospice to be entitled to receive their annual market basket for update beginning in Fiscal Year 2014.

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Annual Cost to Federal Government: $1,583,500

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]? Yes

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: 03/20/2017

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