The Home Health Care CAHPS® Survey (HHCAHPS) Mode Experiment (CMS-10784)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10784 Mode Experiment	Form and Instruction	New	Available
HHCAHPSSupportingStatementA.docx	Supporting Statement A	Uploaded 2021-10-15	Missing upstream
AttA2CrsswlkHHCAHPSModeExpSurv.pdf	Supplementary Document	Uploaded 2021-10-13	Repair queued
HHCAHPSSupportingStatementB.docx	Supporting Statement B	Uploaded 2021-10-13	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
249727	Mode Experiment	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202110-0938-005
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: The Home Health Care CAHPS® Survey (HHCAHPS) Mode Experiment (CMS-10784)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/18/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	6,280	0
Time Burden (Hours)	1,049	0
Cost Burden (Dollars)	0	0

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Abstract: The Centers for Medicare & Medicaid Services (CMS) implements the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS®) Survey to measure and publicly report patients’ experiences with the health care they receive from Medicare-certified home health agencies (HHAs). National implementation of the survey launched in October 2009. Since October 1, 2010, HHAs have been required to participate on a monthly basis to receive the full Annual Payment Update (APU). Public reporting of the results on a CMS website started in April 2012. Implementation is ongoing with monthly data collection. In recent years, CMS has received feedback from HHA stakeholders requesting (1) the option to administer the survey using a web mode as an alternative to the existing approved modes of mail only, telephone only, and mixed mode (mail with telephone follow-up); and (2) to shorten the survey instrument. Both suggestions, the focus of this OMB/PRA submission, are aimed in part at improving the survey response rate. CMS plans to use information from this mode experiment to determine whether an additional mode of administration (i.e. Web data collection) should be included in the current national implementation of the HHCAHPS Survey. The national HHCAHPS survey is used by Medicare-certified HHAs to improve their internal quality assurance in the care that they provide in home health, CMS uses the HHCAHPS survey in the Home Health Quality Reporting Program, and consumers use the Survey to evaluate options for home health care. Given the widespread use and importance of this survey, CMS wants to improve current response rates and ensure that the survey remains relevant to all stakeholders.

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Authorizing Statute(s): PL: Pub.L. 115 - 123 1895(b)(3)(B)(v)(II) Name of Law: Social Security 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:
	86 FR 42841	08/05/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 57151	10/14/2021
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
Mode Experiment	CMS-10784, CMS-10784	Home Health Care CAHPS Mail Survey ,   Home Health Care CAHPS Web Survey

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	6,280	0	0	0	6,280	0
Annual Time Burden (Hours)	1,049	0	0	0	1,049	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: $617,501

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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]? 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? No

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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: 10/18/2021

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