Hospital Reporting Initiative--Hospital Quality Measures (CMS-10210)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10210 THA/TKA Patient-Reported Outcome-based Performance Measure	Form and Instruction	Modified	Available
Form CMS-10210 Hospital Inpatient Quality Reporting Program Denominator Declaration	Form and Instruction	Modified	Available
Form CMS-10210 Population and Sampling	Form and Instruction	Modified	Available
Form CMS-10210 Maternal Morbidity Structural Measure	Form and Instruction	Modified	Available
Form CMS-10210 Validation Educational Review Form	Form and Instruction	Modified	Available
Form CMS-10210 HVBP CMS Independent Review Form	Form and Instruction	Modified	Available
Form CMS-10210 VBP Appeal Request Form	Form and Instruction	Modified	Available
Form CMS-10210 Validation Review for Reconsideration Request	Form and Instruction	Modified	Available
Form CMS-10210 IQR Reconsideration Request Form	Form and Instruction	Modified	Available
Form CMS-10210 IQR Notice of Participation Form	Form and Instruction	Modified	Available
Form CMS-10210 Hospital Compare Request Form for Withholding/Footnoting Data for Public Reporting	Form and Instruction	Modified	Available
Form CMS-10210 Extraordinary Circumstances Form	Form and Instruction	Modified	Available
Form CMS-10210 Hospital VPB Review and Corrections Form	Form and Instruction	Modified	Available
Form CMS-10210 Data Accuracy and Completeness Form	Form and Instruction	Modified	Available
Form CMS-10210 Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	Repair queued
CMS-10210 HIQR FY 2026 PR Supporting Statement B clean.docx	Supporting Statement B	Uploaded 2025-06-25	Available
CMS-10210 HIQR FY 2026 PR Supporting Statement B clean.docx	Supporting Statement B	Uploaded 2025-06-25	Available
CMS-10210 HIQR FY 2026 PR Supporting Statement A CLEAN 06192025.docx	Supporting Statement A	Uploaded 2025-06-25	Available
CMS-10210 HIQR FY 2026 PR Supporting Statement A CLEAN 06192025.docx	Supporting Statement A	Uploaded 2025-06-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	THA/TKA Patient-Reported Outcome-based Performance Measure
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	Hospital Inpatient Quality Reporting Program Denominator Declaration
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	Population and Sampling
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	Maternal Morbidity Structural Measure
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	Validation Educational Review Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	HVBP CMS Independent Review Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	VBP Appeal Request Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	Validation Review for Reconsideration Request
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	IQR Reconsideration Request Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	IQR Notice of Participation Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	Hospital Compare Request Form for Withholding/Footnoting Data for Public Reporting
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	Extraordinary Circumstances Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	Hospital VPB Review and Corrections Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified	Data Accuracy and Completeness Form
204350	Quality Measures and Procedures for Hospital Reporting of Quality Data	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1022	ICR Reference No: 202506-0938-015
Status: Historical Inactive	Previous ICR Reference No: 202409-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Hospital Reporting Initiative--Hospital Quality Measures (CMS-10210)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule and continue	Conclusion Date: 07/31/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/30/2025
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is not approved at this time. Prior to publication of the final rule, the agency should provide to OMB a summary of all comments received on the proposed information collection and identify any changes made in response to these comments.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2026	36 Months From Approved	01/31/2026
Responses	18,000	0	18,000
Time Burden (Hours)	2,283,878	0	2,283,878
Cost Burden (Dollars)	0	0	0

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Abstract: This request covers data collection requirements for the FY 2027 payment determination and subsequent years. This revised information collection request includes burden for the proposed adoption of the Age Friendly Hospital measure, the proposed increase in the number of eCQMs hospitals would be required to report, and the removal of the Measure Exception Form for NHSN HAI Measures from this information collection in addition to updated data and wage rates impacting previously approved burden calculations.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 5001(b) Name of Law: Medicare Prescription Drug, Improvement and Modernization Act of 2003
   PL: Pub.L. 111 - 148 3001 Name of Law: Affordable Care Act
   PL: Pub.L. 109 - 171 5001(a) Name of Law: Hospital Quality Improvement
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV45	Proposed rulemaking	90 FR 18002	04/30/2025

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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: 1

table that charts list of burden

IC Title	Form No.	Form Name
Quality Measures and Procedures for Hospital Reporting of Quality Data	CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210, CMS-10210	Data Accuracy and Completeness Form ,   Hospital VPB Review and Corrections Form ,   Extraordinary Circumstances Form ,   Hospital Compare Request Form for Withholding/Footnoting Data for Public Reporting ,   IQR Notice of Participation Form ,   IQR Reconsideration Request Form ,   Validation Review for Reconsideration Request ,   VBP Appeal Request Form ,   HVBP CMS Independent Review Form ,   Validation Educational Review Form ,   Maternal Morbidity Structural Measure ,   Population and Sampling ,   Hospital Inpatient Quality Reporting Program Denominator Declaration ,   THA/TKA Patient-Reported Outcome-based Performance Measure

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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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The proposal in the FY 2026 IPPS/LTCH PPS proposed rule to remove the Hospital Commitment to Health Equity measure beginning with the FY 2026 payment determination results in an annual burden decrease of 759 hours and $42,033. The proposals to remove the Screening for Social Drivers of Health and Screen Positive Rate for Social Drivers of Health result in an annual burden decrease of 934,685 hours and $24,001,129. The adjustment to remove the burden hours associated with reviewing HSRs for claims-based measure sets results in a decrease of 18,200 hours and $1,007,916. The aggregate decrease due to these policies and adjustments is 953,644 hours (-759 – 934,685 - 18,200) and $25,051,078 (-$42,033 - $24,001,129 - $1,007,916).

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Annual Cost to Federal Government: $10,582,965

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: 06/30/2025

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