Hospice Quality Reporting Program (CMS-10390)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10390 HOPE v1.00_All Item_Final_022625	Form and Instruction	Modified	Repair queued
Form CMS-10390 HOPE and HUV Timepoint	Form	Modified	Repair queued
Form CMS-10390 HOPE v1.00_All Item_Final_022625	Form and Instruction	Modified	Repair queued
Form CMS-10390 HOPE v1.00_HOPE Update Visit_Final_022625	Form and Instruction	Modified	Repair queued
Form CMS-10390 HOPE v1.00_Admission_Final_022625	Form and Instruction	Modified	Repair queued
Form CMS-10390 HOPE v1.00_Discharge_Final_022625	Form and Instruction	Modified	Repair queued
Form CMS-10390 Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	Form and Instruction	Modified	Repair queued
CMS-10390 - HOPE Supporting Statement Part A (final 3-13-25).docx	Supporting Statement A	Uploaded 2025-03-13	Repair queued
CMS-10390 - HOPE PRA Supporting Statement Part A.docx	Supporting Statement A	Uploaded 2024-09-04	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
269622	HOPE and HUV Timepoint	Form and Instruction	Modified	HOPE v1.00_All Item_Final_022625
269622	HOPE and HUV Timepoint	Form	Modified
203679	Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	Form and Instruction	Modified	HOPE v1.00_All Item_Final_022625
203679	Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	Form and Instruction	Modified	HOPE v1.00_HOPE Update Visit_Final_022625
203679	Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	Form and Instruction	Modified	HOPE v1.00_Admission_Final_022625
203679	Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	Form and Instruction	Modified	HOPE v1.00_Discharge_Final_022625
203679	Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1153	ICR Reference No: 202409-0938-004
Status: Active	Previous ICR Reference No: 202407-0938-018
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Hospice Quality Reporting Program (CMS-10390)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/17/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/05/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2028	36 Months From Approved	01/31/2026
Responses	5,527,450	0	2,763,850
Time Burden (Hours)	3,811,348	0	1,323,883
Cost Burden (Dollars)	0	0	0

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Abstract: The Hospice Item Set (HIS) is used for the collection of quality measure data related to the Hospice Quality Reporting Program (HQRP), and the HIS V1.00.0 specified the collection of data items that supported seven Consensus Based Entity (CBE) endorsed Quality Measures (QMs) for hospice. On April 1, 2017, hospices began using an updated HIS V2.00.0, which includes the same items from the HIS V1.00.0 along with the addition of several new items for use in new measures, measure refinement, patient record matching, and future public reporting. Data collected from the HIS are used to calculate the seven CBE-endorsed QMs and the CBE-endorsed Hospice and Palliative Care Composite Process Measure – Comprehensive Assessment at Admission QM. During the FY 2021 rule, the Hospice Visits when Death is Imminent measure pair was removed and replaced with the claims-based Hospice Visits in Last Days of Life (HVLDL) measure. The reduction in provider burden and costs occurred when CMS replaced the HIS-based HVWDII quality measure via the HIS-PRA package that OMB approved on February 16, 2021 (OMB Control Number: 0938-1153). CMS is requesting to extend the existing expiration date (February 29, 2024) for an additional 3 years.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 3004 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV29	Final or interim final rulemaking	89 FR 64202	08/06/2024

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
HOPE and HUV Timepoint	CMS-10390	HOPE v1.00_All Item_Final_022625
Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form	CMS-10390, CMS-10390, CMS-10390, CMS-10390	HOPE v1.00_Discharge_Final_022625 ,   HOPE v1.00_Admission_Final_022625 ,   HOPE v1.00_HOPE Update Visit_Final_022625 ,   HOPE v1.00_All Item_Final_022625

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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	5,527,450	2,763,850	0	0	2,763,600	0
Annual Time Burden (Hours)	3,811,348	1,323,883	0	0	2,487,465	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: Because HOPE contains a new timepoint and several new data elements in its admission timepoint, the burden hours and costs have increased from the previous Hospice Item Set. Burden increases mainly stem from the addition of the HUV timepoint, which adds an additional 22 minutes of clinical time and 5 minutes of administrative time. The expansion of the HOPE Admission timepoint (when compared to HIS Admission) also accounts for an increase in burden hours (27 additional minutes). Thus, burden hours increased by 2,487,466 hours.

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Annual Cost to Federal Government: $1,583,500

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: 09/05/2024

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