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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10036 IRF- PAI vesion 4.0	Form and Instruction	Modified	Available
Form CMS-10036 Inpatient Rehabilitation Facility - Patient Assessment Instrument	Form and Instruction	Unchanged	Repair queued
CMS-10036_Response to Comments_v4 4-13-2022.docx	Supplementary Document	Uploaded 2022-04-13	Repair queued
CMS-10036-Supporting-Statement-A 4-7-22.docx	Supporting Statement A	Uploaded 2022-04-12	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210555	Inpatient Rehabilitation Facility - Patient Assessment Instrument	Form and Instruction	Modified	IRF- PAI vesion 4.0
210555	Inpatient Rehabilitation Facility - Patient Assessment Instrument	Form and Instruction	Unchanged
210555	Inpatient Rehabilitation Facility - Patient Assessment Instrument	Instruction	Modified

ICR Details

OMB Control No: 0938-0842	ICR Reference No: 202204-0938-001
Status: Historical Active	Previous ICR Reference No: 202112-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Inpatient Rehabilitation Assessment Instrument and Data Set for PPS for Inpatient Rehabilitation Facilities (CMS-10036)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/03/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/14/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2025	36 Months From Approved	12/31/2022
Responses	411,622	0	411,081
Time Burden (Hours)	727,198	0	704,747
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Medicare & Medicaid Services (CMS) is requesting an extension of the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) Version 4.0 that will be effective on October 1, 2022. On November 2, 2021 the Centers for Medicare & Medicaid Services (CMS) issued a final rule (86FR 62240) which finalized proposed modifications to the effective date for the reporting of measures and certain standardized patient assessment data in the Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP). Per the final rule CMS will require IRFs to start collecting assessment data using IRF-PAI Version 4.0 beginning October 1, 2022. The rule is available here: https://www.federalregister.gov/documents/2021/11/09/2021-23993/medicare-and-medicaid-programs-cy-2022-home-health-prospective-payment-system-rate-update-home The information collection request for IRF PAI 4.0 was re-approved on 12/15/2021 with an October 1, 2022 implementation date. CMS is asking for an extension of the approved IRF-PAI Version 4.0, which expires on December 31, 2022. The burden associated with this requirement is staff time required to complete and encode the data from the IRF-PAI. The burden associated with collecting and transmitting the data is unaffected by the proposed extension to the assessment instrument.

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

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:
	87 FR 6175	02/03/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 21661	04/12/2022
Did the Agency receive public comments on this ICR? Yes

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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 Rehabilitation Facility - Patient Assessment Instrument	CMS-10036	IRF- PAI vesion 4.0

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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	411,622	411,081	0	0	541	0
Annual Time Burden (Hours)	727,198	704,747	0	0	22,451	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: $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? Yes

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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: 04/14/2022

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