View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1022
ICR Reference No:
201910-0938-001
Status:
Historical Active
Previous ICR Reference No:
201905-0938-008
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CMS-10210
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:
Approved with change
Conclusion Date:
12/23/2019
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/30/2019
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2022
36 Months From Approved
02/28/2022
Responses
17,600
0
17,600
Time Burden (Hours)
1,612,710
0
2,520,100
Cost Burden (Dollars)
0
0
0
Abstract:
In the FY 2020 IPPS/LTCH PPS proposed rule, we are proposing to adopt the Hybrid Hospital-Wide Readmission Measure With Claims and Electronic Health Record Data (NQF #2879).
Authorizing Statute(s):
PL:
Pub.L. 109 - 171 5001(a)
Name of Law: Hospital Quality Improvement
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
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AT73
Final or interim final rulemaking
84 FR 42044
08/16/2019
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
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, 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 Measure Exception Form
,
IQR Notice of Participation Form
,
IQR Reconsideration Request Form
,
CAUTI Validation Template
,
CDI Validation Template
,
CLABSI Validation Template 1Q18-2Q18
,
MRSA Validation Template
,
Validation Review for Reconsideration Request
,
VBP Appeal Request Form
,
HVBP CMS Independent Review Form
,
Validation Educational Review Form
ICR Summary 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
17,600
17,600
0
0
0
0
Annual Time Burden (Hours)
1,612,710
2,520,100
0
-907,390
0
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
We previously requested and received approval for total annual burden estimates under this OMB control number for the CY 2019 reporting period/FY 2021 payment determination of 2,520,100 hours as a result of policies finalized in the FY 2019 IPPS/LTCH PPS final rule. Additionally, we previously submitted total annual burden estimates under this OMB control number for the CY 2020 reporting period/FY 2022 payment determination of 1,612,710 hours – a total burden decrease of 907,390 hours – as a result of policies finalized in the FY 2019 IPPS/LTCH PPS final rule.
Annual Cost to Federal Government:
$10,340,910
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?
Uncollected
Agency Contact:
Denise King 410 786-1013 Denise.King@cms.hhs.gov
Common Form ICR:
No
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:
10/30/2019
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