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OMB Control No: 0938-1140	ICR Reference No: 202206-0938-012
Status: Historical Active	Previous ICR Reference No: 202009-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Minimum Data Set 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) for the Collection of Data Related to the Patient Driven Payment Model and the Skilled Nursing Facility QRP (CMS-10387)
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: 11/22/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/13/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2025	36 Months From Approved	11/30/2022
Responses	4,905,042	0	4,905,042
Time Burden (Hours)	4,169,286	0	4,169,286
Cost Burden (Dollars)	0	0	0

Abstract: The Minimum Data Set (MDS) is a uniform instrument used in every Medicare/Medicaid certified nursing home in the United States to assess resident condition. It was developed in response to the Landmark Institute of Medicine (IOM) Report on Nursing Home Quality in 1987 where the MDS was seen as a critical component in efforts to improve the quality of care in nursing homes. The Omnibus Reconciliation Act of 1987 (OBRA 1987) also set forth new provisions for Medicare and Medicaid related to new standards for care in the nursing home setting. From its inception, the MDS was intended to serve several purposes: (1) Collect data to inform care plans (2) To generate quality indicators to evaluate nursing homes and guide improvement interventions (3) To serve as a data source for nursing home payment systems. Pursuant to sections 4204(b) and 4214(d) of OBRA 1987, the current requirements related to the submission and retention of resident assessment data are not subject to the Paperwork Reduction Act (PRA), but it has been determined that requirements for SNF staff performing, encoding and patient assessment data necessary administer the payment rate methodology described in 413.337, are subject to the PRA. The SNF QRP was established in CMS-1622-F (August 4, 2015; 80 FR 46390) and began collecting data from SNFs in fiscal year (FY) 2016 using the MDS. As described in section 1899B (b)(1)(B) of the Social Security Act (the Act), SNFs are required to submit standardized patient assessment data with respect to the following categories: • Functional Status • Cognitive Function • Special Services, Treatments, and Interventions • Medical Conditions and Comorbidities • Impairments • Other categories deemed necessary and appropriate by the Secretary Both the Patient Driven Payment Model (PDPM) in the SNF PPS and the SNF QRP collect data through the MDS 3.0. The PDPM was described and adopted for SNFs and Swing Beds in CMS-1696-F (August 8, 2018; 83 FR 39162). The Centers for Medicare & Medicaid Services (CMS) is requesting to implement the MDS 3.0 v1.17.2 from Oct 1, 2020 to Oct 1, 2023. When CMS implemented the new payment model for SNF Part A covered services, the OBRA assessments were not updated to include the new data elements for calculating the Patient Driven Payment Model (PDPM) payment codes. State Medicaid Agencies requested that these items be added to the OBRA assessments (NC and NQ) so they could collect the new items and use the information to develop their future payment models. However, the OBRA assessments are PRA exempt, and the item set changes only consisted of changes in instructional language on the NC and NQ Item Sets, and therefore do not reflect any change in burden from the previous version, MDS 3.0 v1.17.1. These changes are described below, on page 2 of the document MDS3.0_Item_Changes_v1.17.2.pdf, and again in Section B.15 of this supporting statement.

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:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 16739	03/24/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 35216	06/09/2022
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	4,905,042	4,905,042
Annual Time Burden (Hours)	4,169,286	4,169,286
Annual Cost Burden (Dollars)	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: No

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $3,164,707

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]? 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? Yes

Agency Contact: Denise King 410 786-1013 Denise.King@cms.hhs.gov

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