Hospice Quality Reporting Program (CMS-10390)

Forms and Documents

Document Name	Status
Form CMS-10390 Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form Form and Instruction	Modified
CMS-10390 - Supporting Statement Part A_30day.docx Supporting Statement A	2018-03-27

IC Document Collections

IC ID	Document Title	Status
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: 201803-0938-009
Status: Active	Previous ICR Reference No: 201703-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: 21627
Title: Hospice Quality Reporting Program (CMS-10390)
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: 08/14/2018
	Date Received in OIRA: 03/28/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2021	36 Months From Approved	08/31/2018
Responses	4,259	0	4,259
Time Burden (Hours)	686,631	0	686,631
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:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 2785	01/19/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 13129	03/27/2018
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
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

	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	4,259	0	0	0	0
Annual Time Burden (Hours)	686,631	686,631	0	0	0	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:

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

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: 03/28/2018

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