National Implementation of the Hospice Experience of Care Survey (CAHPs Hospice Survey) - CMS-10537

Forms and Documents

Document Name	Status
Form CMS-10537 National Implementation Form and Instruction	Modified
Hospice Survey OMB_Statement_A _5-2017.docx Supporting Statement A	2017-05-03
Hospice Survey OMB_Statement_B_04-20-17.pdf Supporting Statement B	2017-05-02

IC Document Collections

IC ID	Document Title	Status
212900	Mode Experiment	Removed
212899	National Implementation Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1257	ICR Reference No: 201705-0938-002
Status: Historical Inactive	Previous ICR Reference No: 201408-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: National Implementation of the Hospice Experience of Care Survey (CAHPs Hospice Survey) - CMS-10537
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule and continue	Conclusion Date: 07/24/2017
	Date Received in OIRA: 05/04/2017
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is not approved at this time. Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	36 Months From Approved	12/31/2017
Responses	561,026	0	561,026
Time Burden (Hours)	98,179	0	98,179
Cost Burden (Dollars)	0	0	0

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Abstract: Hospice currently serves approximately 42% of dying patients in the United States. Medicare covers most hospice patients under a benefit created in 1983 to provide palliative care at the end of life. Despite its 30-year history as a Medicare benefit, to date no single survey has been systematically administered by all hospices across the country to assess experiences of hospice care. This submission requests approval for national implementation of the CAHPS® Hospice Survey and as well as approval for a mode experiment to test for mode effects, if any, when the survey is implemented. The CAHPS® Hospice Survey will sample caregivers of patients who died while under hospice care. Survey administration will start between 2 and 3 months after the death of the patient. The sample will be provided by the hospice program. This information will ultimately be used to improve hospice care throughout the country. The mod experiment is intended to determine what mode effects, if any, are found while implementing the survey. Three modes will be tested: mail-only, telephone-only, and mixed-mode (mail with telephone follow up). The mode experiment will occur simultaneously with the first year of National Implementation of the survey, which is also covered as part of this submission.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3004 Name of Law: 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-AT00	Proposed rulemaking	82 FR 20750	05/03/2017

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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

IC Title	Form No.	Form Name
Mode Experiment
National Implementation	CMS-10537, CMS-10537	CAHPS Hospice Telephone Survey ,   CAHPS Hospice Mail Survey

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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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The number of respondents subject to the National Implementation of the CAHPS® Hospice Survey has increase significantly from 561,026 in 2014 to 951,482 for 2017. The 2017 estimate is based on CMS’ actual experience with the CAHPS® Hospice Survey, as well as experience with surveys of similar length that were fielded with Medicare beneficiaries. The significant increase in respondents resulted in an overall burden hour increase of 68,329 hours (from 98,179 hours to 166,508 hours). The Hospice CAHPS Mode Experiment was a one-time data collection effort which was included in the previous OMB package and burden estimates. However, once the experiment was completed, it has not been repeated; no additional data collection has occurred; none is anticipated. For these reasons, the Mode Experiment has been removed from this ICR which results in a 3,150 burden hour reduction.

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Annual Cost to Federal Government: $1,583,796

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: 05/04/2017

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