OMB control number
Long Term Care Hospital (LTCH) Quality Reporting Program (CMS-10409)
OMB 0938-1163 · HHS/CMS.
OMB 0938-1163
The Centers for Medicare & Medicaid Services (CMS) is requesting approval of revisions to the Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) Version 5.2 that will be effective October 1, 2026.
The latest form for Long Term Care Hospital (LTCH) Quality Reporting Program (CMS-10409) expires 2027-10-31 and is listed under ICR 202508-0938-015.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10409 LCDS version 5.3 Unplanned Discharge | Form and Instruction |
| Form CMS-10409 LCDS version 5.3 Planned Discharge | Form and Instruction |
| Form CMS-10409 LCDS version 5.3 Expired | Form and Instruction |
| Form CMS-10409 LCDS version 5.3 Admission | Form and Instruction |
 CMS_10409_Supporting_Statement_LCDS_v5.3_4-30-26.docx | Supporting Statement A |
 Long Term Care Data Set |
Form and Instruction |
| Long Term Care Data Set |
Form and Instruction |
| Long Term Care Data Set |
Form and Instruction |
| Long Term Care Data Set |
Form and Instruction |