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OMB Control No: 0938-1140	ICR Reference No: 201305-0938-024
Status: Historical Inactive	Previous ICR Reference No: 201109-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: 19699
Title: Skilled Nursing Facility (SNF) Minimum Data Set (MDS) 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) Item Sets (NP, NO/SO, NS, NOD, NSD) and Supporting Regulations
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: 09/26/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/29/2013
Terms of Clearance: Comment Filed.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2014	36 Months From Approved	09/30/2014
Responses	884,492	0	884,492
Time Burden (Hours)	913,884	0	913,884
Cost Burden (Dollars)	0	0	0

Abstract: This PRA package proposes to add Prospective Payment System (PPS)-related Item O0420 to the Minimum Data Set (MDS) 3.0 form to capture the number of distinct calendar days a SNF resident has received therapy in a seven-day look-back period. The new PPS-Item (O0420) would be added to allow the Resource Utilization Group (RUG)-IV grouper software to accurately calculate the number of distinct calendar therapy days a SNF resident has received in order to place him or her into the correct RUG-IV payment group. We are requesting revision of resident assessment information that SNFs are required to submit as described at 42 CFR 413.343 and 483.20 in the manner necessary to administer the payment rate methodology described in 42 CFR 413.337.

Authorizing Statute(s): US Code: 42 USC 1395yy(e) Name of Law: Payment to Skilled Nursing Facilities for Routine Costs
PL: Pub.L. 105 - 33 4432(a) Name of Law: Prospective Payment for Skilled Nursing Facilities

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AR65	Proposed rulemaking	78 FR 26438	04/06/2013

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 26438	04/06/2013
Did the Agency receive public comments on this ICR? No

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: While we are proposing to add Item O0420 to the MDS 3.0 form, we do not believe this action will cause any measurable adjustments to our burden estimates. As required under Section 1888(e)(7) of the Act, skilled nursing facilities must be reimbursed under the SNF PPS. We have updated the MDS burden estimates on skilled nursing facilities by making this revision to include the PPS Item Set (NP), The Start of Therapy (NS), the COT/EOT OMRA combined with Discharge (NOD), and the Start of Therapy combined with Discharge (NSD) under the OMB Control Number that was approved for the COT/EOT OMRA (NO/SO) in FY2011. The hourly burden estimate for each assessment has not changed. However, because the rest of the PPS Item Sets are used more frequently than the COT/EOT OMRA item set (NO/SO), we have updated the burden and cost estimates to account for the frequency with which the rest of the assessment Item Sets are completed . Furthermore, the original frequency estimates utilized to calculate burden for the COT OMRA were estimated since the COT OMRA had not been in effect at the time of the burden calculation. We have used FY2012 data to calculate the actual frequency and numbers of assessments completed. Although the total number of items between the various item sets used for PPS assessments, which are listed above, may vary, the NO/NS item set contains the maximum number of payment related items. The NP and NOD item sets include the same number of payment items as the NO/NS item set and the NS and NSD item sets include fewer items since the assessment determines payment for a smaller subset of payment groups. Additionally, the non-payment items used for quality and care planning purposes vary between item sets. Quality or care planning items are exempt from PRA consideration pursuant to sections 4204(b) and 4214(d) of OBRA 1987 and therefore the hourly burden estimate for all of the PPS item sets are the same and only the frequency at which they are required for completion varies. Any burden estimate changes from FY 2011 and now reflect the frequency with which the assessments are completed. This includes all of the updated wage and SNF demographic data.

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

Agency Contact: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov

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