CAHPS Hospice Survey CMS-10537)

Forms and Documents

Document Name	Status
Form CMS-10537 National Implementation Form and Instruction	Modified
Hospice Survey OMB_Statement_B.docx Supporting Statement B	2024-07-10
Hospice Survey OMB_Statement_A 30 Day clean.docx Supporting Statement A	2024-07-10
CMS Response to Public Comments Received for CMS-10537_60 Day.docx Supplementary Document	2024-07-10
CAHPS Hospice Crosswalk 2024_3_21.pdf Supplementary Document	2024-07-10

IC Document Collections

IC ID	Document Title	Status
212899	National Implementation Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1257	ICR Reference No: 202407-0938-002
Status: Received in OIRA	Previous ICR Reference No: 202304-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: CM
Title: CAHPS Hospice Survey CMS-10537)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/10/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2026
Responses	1,159,420	1,140,695
Time Burden (Hours)	168,116	198,481
Cost Burden (Dollars)	0	0

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Abstract: Hospice currently serves approximately 42% of dying patients in the United States. Medicare covers most hospice patients under a benefit created in 1983 to provide palliative care at the end of life. Despite its 30-year history as a Medicare benefit, to date no single survey has been systematically administered by all hospices across the country to assess experiences of hospice care. This submission requests approval for national implementation of the CAHPS® Hospice Survey and as well as approval for a mode experiment to test for mode effects, if any, when the survey is implemented. The CAHPS® Hospice Survey will sample caregivers of patients who died while under hospice care. Survey administration will start between 2 and 3 months after the death of the patient. The sample will be provided by the hospice program. This information will ultimately be used to improve hospice care throughout the country. The mod experiment is intended to determine what mode effects, if any, are found while implementing the survey. Three modes will be tested: mail-only, telephone-only, and mixed-mode (mail with telephone follow up). The mode experiment will occur simultaneously with the first year of National Implementation of the survey, which is also covered as part of this submission.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3004 Name of Law: 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:
	89 FR 23598	04/04/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 56383	07/09/2024
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
National Implementation	CMS-10537, CMS-10537, CMS-10537, CMS-10537, CMS-10537, CMS-10537, CMS-10537, CMS-10537, CMS-10537	Hospice Experience of Care Survey - ,   CAHPS Hospice Survey_Korean_ ,   CAHPS Hospice Survey_Polish ,   CAHPS Hospice Survey_Portuguese_ ,   CAHPS Hospice Survey_Russian_ ,   CAHPS Hospice Survey_Simplified Chinese_ ,   CAHPS Hospice Survey_Spanish_ ,   CAHPS Hospice_Vietnamese Survey_ ,   CAHPS Hospice Survey_Traditional Chinese

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ICR Summary 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	1,159,420	1,140,695	0	0	18,725	0
Annual Time Burden (Hours)	168,116	198,481	0	0	-30,365	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: The collections total hourly burden has decreased due to the removal of multiple items on the CAHPS Hospice Survey to shorten the document.

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Annual Cost to Federal Government: $2,000,000

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? 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: 07/10/2024

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