(CMS-10036) Inpatient Rehabilitation Assessment Instrument and Data Set for PPS for Inpatient Rehabilitation Facilities

Forms and Documents

Document Name	Status
Form CMS-10036 Inpatient Rehabilitation Facility - Patient Assessment Instrument Form and Instruction	Modified
CMS-10036 Supporting Statement A (7-31-17)_clean.docx Supporting Statement A	2017-08-01

IC Document Collections

IC ID	Document Title	Status
210555	Inpatient Rehabilitation Facility - Patient Assessment Instrument Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0842	ICR Reference No: 201710-0938-007
Status: Historical Active	Previous ICR Reference No: 201402-0938-016
Agency/Subagency: HHS/CMS	Agency Tracking No: 21520
Title: (CMS-10036) Inpatient Rehabilitation Assessment Instrument and Data Set for PPS for Inpatient Rehabilitation Facilities
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: 10/13/2017
	Date Received in OIRA: 10/13/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	10/31/2017
Responses	402,311	0	359,000
Time Burden (Hours)	227,151	0	197,080
Cost Burden (Dollars)	0	0	0

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Abstract: We are requesting approval for revisions to the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI). This is the assessment instrument that Inpatient Rehabilitation Facilities (IRFs) are required to submit in order for CMS to administer the payment rate methodolgy under the IRF PPS described in 42 CFR 412 Subpart P. The burden associated with this requirement is the staff time required to complete and encode the data from the IRF-PAI. The burden associated with transmitting the IRF-PAI is not being included in this revision, since the requirement for IRFs to transmit the data is unaffected by the proposed revision to the assessment instrument. We are proposing the following revisions to the IRF-PAI: Updates Associated with IRF-PAI Version 1.3 (Effective October 1, 2015) We are proposing to add an item (24A) to the IRF PAI to record arthritis conditions as part of our continued monitoring of the IRF benefit. We are also proposing to add items (O0401 and O0402) to the IRF PAI to record how much and what mode of therapy (i.e., individual, group, co-treatment) patients receive in each therapy discipline (i.e., physical therapy, occupational therapy, and speech-language pathology) as part of our continued monitoring and oversight of the IRF benefit, as well as to inform the necessity of any future policy making. Updates Associated with IRF-PAI Version 1.4 (Effective October 1, 2016) – Exempt from PRA In the IRF PPS Final Rule FY 2016 , several quality measures were finalized for the IRF QRP which require modification to the IRF-PAI Version 1.4, effective October 1, 2016. We note that the burden associated with the these measures is exempt from the PRA under the IMPACT Act of 2014 but have provided it on the supporting statement. Updates Associated with IRF-PAI Version 1.5 (Effective October 1, 2017) We are proposing to remove an item (27) from the IRF PAI. This item is no longer needed, as new quality items have been added to Section K. Updates Associated with IRF-PAI Version 2.0 (Effective October 1, 2018) – Exempt from PRA In the FY 2017 IRF PPS final rule, we adopted 1 assessment-based measure to meet the requirements of the IMPACT Act. The Drug Regimen Review Conducted With Follow-Up for Identified Issues- Post Acute Care (PAC) Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) measure was adopted for the FY 2020 and subsequent payment determinations. In the FY 2018 IRF PPS proposed rule, we proposed to adopt 1 measure and remove 2 measures. The proposed measure for adoption is Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury. The proposed measures for removal are Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678) and the All-Cause Unplanned Readmission Measure for 30 Days Post Discharge from Inpatient Rehabilitation Facilities (NQF #2502). We also proposed adding standardized patient assessment data, including 23 items on admission and 24 items on discharge. Section 1886(j)(7)(F)(iii) of the Act requires that for fiscal years 2019 and each subsequent year, IRFs report standardized patient assessment data required under section 1899B9b)(1) of the Act, using the standard instrument in a time, form, and manner specified by the Secretary.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3004 Name of Law: Quality Reporting for Long-Term Care Hospitals, etc.
   PL: Pub.L. 105 - 1 4421 Name of Law: Prospective Payment for Inpatient Rehab Hospital Services
   US Code: 42 USC 1395ww(jX2)(d) Name of Law: Prospective Payment for Inpatient Rehab Services
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AS99	Final or interim final rulemaking	82 FR 36238	08/03/2017

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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
Inpatient Rehabilitation Facility - Patient Assessment Instrument	CMS-10036, CMS-10036	IRF-PAI instrument ,   IRF-PAI Intrument

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ICR Summary 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	402,311	359,000	0	43,311	0	0
Annual Time Burden (Hours)	227,151	197,080	0	30,071	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 supporting statement finalizes the burden related to IRF-PAI Versions 1.3, 1.4, 1.5 and 2.0. The changes to the IRF-PAI burden is unchanged for Versions 1.3, 1.4, and 1.5. However, we would like to note that through the FY 2018 IRF PPS final rule, we decided to delay the adoption of the standardized patient assessment data elements to fulfill the requirements of the IMPACT Act in the categories of cognitive function and mental status, special services, treatments, and interventions, and impairments and are no longer included in IRF-PAI Version 2.0. There was no change to the annual burden hours related to these data elements. Items added to the IRF-PAI Versions 1.4 and 2.0 are currently exempt from PRA and are provided for informational purposes only.

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Annual Cost to Federal Government: $3,154,694

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.     Yes

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.     Yes

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: 08/01/2017

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