Long Term Care Hospital (LTCH) Quality Reporting Program (CMS-10409)

ICR 202009-0938-012

OMB: 0938-1163

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2020-09-23
Supporting Statement A
2020-09-23
IC Document Collections
IC ID
Document
Title
Status
201171 Modified
ICR Details
0938-1163 202009-0938-012
Active 201910-0938-002
HHS/CMS CCSQ
Long Term Care Hospital (LTCH) Quality Reporting Program (CMS-10409)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 09/30/2020
Retrieve Notice of Action (NOA) 09/24/2020
  Inventory as of this Action Requested Previously Approved
12/31/2022 12/31/2022 12/31/2022
272,952 0 204,936
121,674 0 145,831
0 0 0

We are requesting approval for revisions to the LTCH CARE Data Set in the FY 2020 IPPS/LTCH PPS rule. The LTCH CARE Data Set is used to collect, submit, and report quality data to CMS for compliance with the Long-Term Care Hospital Quality Reporting Program (LTCH QRP). We are proposing the following revisions to the LTCH CARE Data Set V5.00 (effective October 1, 2020): a) Proposed data elements for the two Transfer of Health Information Measures: Transfer of Health Information to Provider–Post-Acute Care (PAC) and Transfer of Health Information to Patient–Post-Acute Care (PAC) b) Proposed Standardized Patient Assessment Data Elements

PL: Pub.L. 111 - 148 3004 Name of Law: Quality reporting for LTCHs, inpatient rehabilitation hospitals, and hospice programs
  
PL: Pub.L. 111 - 148 3004 Name of Law: Quality reporting for LTCHs, inpatient rehabilitation hospitals, and hospice programs

0938-AT73 Final or interim final rulemaking 84 FR 42044 08/16/2019

No

1
IC Title Form No. Form Name
Long Term Care Data Set CMS-10409, CMS-10409, CMS-10409, CMS-10409 LCDS version 4.00 Admission ,   LCDS version 4.00 Expired ,   LCDS version 4.00 Planned Discharge ,   LCDS version 4.00 Unplanned Discharge

  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 272,952 204,936 0 68,016 0 0
Annual Time Burden (Hours) 121,674 145,831 0 -24,157 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
There is a decrease in burden; as CMS is requesting to revert back to LCDS V4.0. The requested burden hours for LCDS V4.0 was 121,674 hours.

$3,155,500
No
    No
    No
Yes
No
No
Yes
Denise King 410 786-1013 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
09/24/2020


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