Inpatient Psychiatric Facility Quality Reporting Program (CMS-10432)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10432 Substance Use Measure Collection	Form and Instruction	Modified	Available
Form CMS-10432 Transitions Measures Collection Form	Form and Instruction	Modified	Available
Form CMS-10432 TOB IMM Collection Form	Form and Instruction	Modified	Available
Form CMS-10432 Online Data Entry Tool Content for Web-Based Measure Collection	Form and Instruction	Modified	Available
Form CMS-10432 Notice of Participation	Form and Instruction	Modified	Available
Form CMS-10432 IPF Screen shots	Form and Instruction	Modified	Available
Form CMS-10432 FY 2019 Non-Measure Data Collection Paper Tool	Form and Instruction	Modified	Available
Form CMS-10432 Online Data Entry Tool Content for Structural Measures	Form and Instruction	Modified	Available
Form CMS-10432 Vendor Authorization Form	Form and Instruction	Modified	Available
Form CMS-10432 HBIPS Measures Data Collection Tool	Form and Instruction	Modified	Available
Form CMS-10432 IPF Data Accuracy Form	Form and Instruction	Modified	Available
CMS-10432 Final IPFQR Supporting Statement.docx	Supporting Statement A	Uploaded 2017-09-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Substance Use Measure Collection
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Transitions Measures Collection Form
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	TOB IMM Collection Form
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Online Data Entry Tool Content for Web-Based Measure Collection
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Notice of Participation
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	IPF Screen shots
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	FY 2019 Non-Measure Data Collection Paper Tool
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Online Data Entry Tool Content for Structural Measures
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	Vendor Authorization Form
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	HBIPS Measures Data Collection Tool
202349	Inpatient Psychiatric Facility Quality Reporting Program	Form and Instruction	Modified	IPF Data Accuracy Form

ICR Details

OMB Control No: 0938-1171	ICR Reference No: 201709-0938-001
Status: Historical Active	Previous ICR Reference No: 201705-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Inpatient Psychiatric Facility Quality Reporting Program (CMS-10432)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/20/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/20/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2019	36 Months From Approved	07/31/2019
Responses	1,428,032	0	1,428,032
Time Burden (Hours)	4,662,154	0	4,657,944
Cost Burden (Dollars)	0	0	0

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Abstract: Section 10322 of the Affordable Care Act (ACA) authorizes the establishment of a new quality reporting program for Inpatient Psychiatric Facilities (IPFs). The program began with an initial set of 6 measures for FY 2014 and FY 2015 and currently includes 18 measures. For FY 2020 we propose adding one measure calculated from administrative claims. IPFs that fail to comply with the program’s requirements will receive a 2% reduction in their Annual Payment Update (APU). To minimize burden and maximize efficiency, CMS has leveraged existing systems within CMS to collect aggregated data and calculated measure rates from the IPFs, in a form, manner and time as specified by CMS, via a secure portal known as the QualityNet Web site. CMS will use the FY 2014 procedural requirements designed to align with current quality reporting programs. These procedural requirements involve submitting necessary forms (e.g., Notice of Participation Form, Reconsideration Request Form) to comply with the program and align with current CMS reporting requirements for other hospital quality reporting programs. When adding new measures, the law requires CMS, where “feasible and practical”, to select measures put forward by “one or more national consensus building entities”. Section 3013 of the ACA requires CMS to perform a gap analysis for needed quality measures every three years. Section 3014 of the ACA requires CMS to develop quality and efficiency measures through a “consensus-based entity”. Consequently, the Measure Applications Partnership (MAP), convened by the National Quality Forum (NQF), was formed to develop measures consistent with these requirements. CMS reviewed the MAP’s formal recommendations prior to identifying IPFQR measures for the FY 2018 IPPS/LTCH PPS rule.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 10322 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-AS98	Final or interim final rulemaking	82 FR 37990	08/14/2017

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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

table that charts list of burden

IC Title	Form No.	Form Name
Inpatient Psychiatric Facility Quality Reporting Program	CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432, CMS-10432	IPF Data Accuracy Form ,   HBIPS Measures Data Collection Tool ,   Vendor Authorization Form ,   Online Data Entry Tool Content for Structural Measures ,   FY 2019 Non-Measure Data Collection Paper Tool ,   IPF Screen shots ,   Notice of Participation ,   Online Data Entry Tool Content for Web-Based Measure Collection ,   TOB IMM Collection Form ,   Transitions Measures Collection Form ,   Substance Use Measure Collection

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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	1,428,032	1,428,032	0	0	0	0
Annual Time Burden (Hours)	4,662,154	4,657,944	0	4,210	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 FY 2018 IPPS/LTCH PPS Proposed Rule published on April 14, 2017, for the FY 2020 IPFQR Program, CMS proposed to increase this to nineteen (19) measures from eighteen (18), where the newly added measure is calculated from Medicare Part A, Part B, and Part D claims and therefore has no associated burden for facilities. However, in the FY 2018 IPPS/LTCH PPS Final Rule published on August 14, 2017, CMS did not finalize adoption of this measure. Therefore, there is no change to the anticipated burden because of this rule.

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Annual Cost to Federal Government: $106,839

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 09/20/2017

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