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OMB Control No: 0938-1264	ICR Reference No: 201612-0938-008
Status: Historical Active	Previous ICR Reference No: 201412-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Program of all-Inclusive Care for the Elderly PACE Quality Data Entry in the CMS Health Plan Monitoring System (HPMS) (CMS-10525)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/16/2017
	Date Received in OIRA: 12/21/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved	12/31/2017
Responses	1,440	0	64,000
Time Burden (Hours)	330,600	0	46,000
Cost Burden (Dollars)	0	0	0

Abstract: Quality improvement is a major initiative for the Centers for Medicare and Medicaid Services (CMS). With the passing of the Affordable Care Act in March 2010, there is an increased interest in providing quality healthcare for Medicare and Medicaid beneficiaries. Thus, it is imperative that CMS collect data for measuring and evaluating the quality of care provided to PACE participants and to establish PACE quality strategies and benchmarks for PACE organizations. This request is for requiring PACE organizations to enter Level I and Level II data into the CMS's Health Plan Monitoring System (HPMS) (an electronic data entry system) for purpose of analyzing quality of care. Once PACE organizations are entering Level I and Level II data into HPMS, CMS will be able to analyze results for each organization and the PACE program as a whole. We can then use that analysis to develop a quality improvement strategy for PACE.

Authorizing Statute(s): US Code: 42 USC 1934(e)(3)(A) Name of Law: Social Security Act
US Code: 42 USC 1894(b)(2)(A) Name of Law: Social Security Act

Citations for New Statutory Requirements: US Code: 42 USC 1894(b)(2)(A) Name of Law: Social Security Act
US Code: 42 USC 1934(e)(3)(A) Name of Law: Social Security Act

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 38187	06/13/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 87039	12/02/2016
Did the Agency receive public comments on this ICR? Yes

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Level I Monitoring Data Entry	CMS-10525
Level II Monitoring Data Entry	CMS-10525
Quality Measure(s) Data Entry	CMS-10525

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	1,440	64,000	-62,560
Annual Time Burden (Hours)	330,600	46,000	284,600
Annual Cost Burden (Dollars)	0	0	0

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: There are several data quality changes (see Appendix A for a list of this iteration’s quality data) which have no impact on our currently approved burden estimates. The changes were made to mimic industry terminology and standards. More specifically, there was a name change from Prospective enrollees to Denials, there was no change in the intent, however we HPMS to capture the same information. For Census, this information was collected in the HPMS but was not listed under as a certain individual title and therefore the technology within the HPMS system allowed for a title to be created in the system for the number POs in a PO (which is called census). While Immunizations has always been collected, it was inadvertently omitted from the currently approved information collection request. Unusual incidents and Reporting requirements/all reporting is not a new requirement, it’s the old terminology relating to Level I and Level II as Unusual incidents. Additionally, we are: (1) Adjusting our estimated number of respondents from 100 POs to 120 POs. (2) We are adding three (Falls, Falls with Injury and Pressure Ulcer Prevalence) PACE Quality measures adopted from the NQF. (3) While the number of data categories is unchanged, this iteration adds 50 Level I entries and 85 Level II entries. The adjustment is in response to public comment. (4) Based on previous and current public comments we are adjusting Level I response time from 0.25 hr to 2.0 hr. (5) Correcting our calculation for the number of responses which should amount to: # POs x annual frequency of reporting. (6) We propose to collect all PACE quality data into HPMS. Currently, Level I data is entered into HPMS as a narrative for each requirement. The change includes entering all PACE quality data collected in HPMS from a pick list/drop down selection format.

Annual Cost to Federal Government: $19,205

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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