End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience (CMS-10823)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10823 Appendix J	Form and Instruction	New	Available
Form CMS-10823 Appendix I	Form and Instruction	New	Available
Form CMS-10823 Appendix H	Form and Instruction	New	Available
Form CMS-10823 Appendix G	Form and Instruction	New	Available
Form CMS-10823 Appendix F	Form and Instruction	New	Available
Form CMS-10823 Appendix E	Form and Instruction	New	Available
Form CMS-10823 Appendix D	Form and Instruction	New	Available
Form CMS-10823 Appendix C	Form and Instruction	New	Available
Form CMS-10823 Appendix B	Form and Instruction	New	Available
Form CMS-10823 Appendix A	Form and Instruction	New	Available
Form CMS-10823 End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	Form and Instruction	New	Repair queued
CMS-10823 ESRD QIP M&E Supporting Statement Part B 12-20-22.docx	Supporting Statement B	Uploaded 2023-05-09	Repair queued
CMS-10823 ESRD QIP ME Supporting Statement Part A 5-8-23 final.docx	Supporting Statement A	Uploaded 2023-05-09	Repair queued
CMS-10823 ESRD QIP ME Response_to_Public_Comments 4-20-23.doc.docx	Supplementary Document	Uploaded 2023-05-04	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
260048	End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	Form and Instruction	New	Appendix J
260048	End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	Form and Instruction	New	Appendix I
260048	End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	Form and Instruction	New	Appendix H
260048	End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	Form and Instruction	New	Appendix G
260048	End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	Form and Instruction	New	Appendix F
260048	End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	Form and Instruction	New	Appendix E
260048	End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	Form and Instruction	New	Appendix D
260048	End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	Form and Instruction	New	Appendix C
260048	End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	Form and Instruction	New	Appendix B
260048	End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	Form and Instruction	New	Appendix A
260048	End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	Form and Instruction	New

ICR Details

OMB Control No: 0938-1450	ICR Reference No: 202305-0938-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience (CMS-10823)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/28/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/11/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2026	36 Months From Approved
Responses	1,945	0	0
Time Burden (Hours)	604	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This project seeks to answer several research questions specific to health outcomes for dialysis patients as measured by the Centers for Medicare & Medicaid Services (CMS) Quality Incentive Program (QIP). In addition to these QIP-specific research questions, CMS seeks to understand several contextual factors that have the potential to affect dialysis facility performance on the QIP To do so, the study team, using primary data collection, will answer the following research questions related to dialysis quality, access to care and health equity, and quality of life: 1) What aspects of patient dialysis care do patients report as a priority? 2) How, if at all, do dialysis facilities evaluate the quality of care they provide? 3) What strategies do providers and dialysis facilities use to improve access to care for underserved populations? 4) What do patients, providers, and stakeholder organizations believe contributes to high quality of life for patients with ESRD? Do perceptions vary by respondent type or respondent characteristics? 5) How do dialysis facilities measure patient satisfaction and quality of life? 6) How do dialysis providers and stakeholder organizations think quality of life for dialysis patients has changed over time? What was the impetus for that change? To answer these research questions, the study team will conduct in-depth interviews with individuals with ESRD, dialysis facility administrators, dialysis facility social workers, nephrologists, corporate representatives from dialysis organizations, representatives from patient advocacy organizations, and transplant center administrators. The findings from this data collection will allow CMS to understand the contextual factors that impact many of the QIP measures that dialysis facilities are held accountable for, thus making policy adjustments to account for these contextual factors.

---

Authorizing Statute(s): PL: Pub.L. 110 - 275 153(c) Name of Law: Medicare Improvements for Patients and Providers Act (MIPPA) of 2008
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 78685	12/22/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 28554	05/04/2023
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
End-stage Renal Disease (ESRD) Quality Incentive Program (QIP): Study of Quality and Patient Experience	CMS-10823, CMS-10823, CMS-10823, CMS-10823, CMS-10823, CMS-10823, CMS-10823, CMS-10823, CMS-10823, CMS-10823	Appendix A ,   Appendix B ,   Appendix C ,   Appendix D ,   Appendix E ,   Appendix F ,   Appendix G ,   Appendix H ,   Appendix I ,   Appendix J

---

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	1,945	0	0	1,945	0	0
Annual Time Burden (Hours)	604	0	0	604	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 is a new information collection request.

---

Annual Cost to Federal Government: $70,806

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]? 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

---

Common Form ICR:  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:

(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: 05/11/2023

---