Hospice Conditions of Participation (CMS-10277)

Forms and Documents

Document Name	Status
Hospice PRA 2013 CMS-10277 Supporting_Statement_Part_A 5-7-14 Final - 508 Compliant 06.04.14.pdf Supporting Statement A	2014-06-04

IC Document Collections

IC ID	Document Title	Status
211892	Hospice Conditions of Participation 418.58 Phase 3	New
211891	Hospice Conditions of Participation 418.58 Phase 2 aggregate/data analysis	New
211890	Hospice Condition of Participation 418.58 Phase 2 data entry	New
211889	Hospice Conditions of Participation 418.58 Phase 1	New
211888	Hospice Conditions of Participation 418.108(c)(1)	New
211887	Hospice Conditions of Participation 418.110(m)	New
211886	Hospice Conditions of Participation 418.100(e)	New
211885	Hospice Conditions of Participation 418.52(b)	New
211884	Hospice Condtions of Participation 418.52(a)	New
211883	Hospice Conditions of Participation 418.28 develop revocation form	New
211882	Hospice Conditions of Participation 418.24 explain election form	New
211881	Hospice Conditions of Participation 418.28 explain revocation form	New
211880	Hospice Conditons of Participation 418.24 develop election form	New
195470	Hospice Conditions of Participation 418.22(b)(4)	Modified
195469	Hospice Condition of Participation (418.22(b)(4) and (b)(5)	Modified
195468	Hospice Conditions of Participation 418.22(b)(3)	Modified
189585	Hospice Conditions of Participation 418.114 (b)	Modified
189584	Hospice Conditions of Participation 418.114 (d)	Modified
189583	Hospice Conditions of Participation 418.112(e)(3)	Modified
189582	Hospice Conditions of Participation (418.110 (n) new hospice program	Modified
189581	Hospice Conditions of Participation 418.110(n) training	Modified
189580	Hospice Conditions of Participation 418.106(a) and (e)	Modified
189579	Hospice Conditions of Participation 418.78(a)(c)(d) and (e)	Modified
189578	Hospice Conditions of Participation 418.76(b)(c) and (d)	Modified
189577	Hospice Conditions of Participation 418.56(b) and (c)	Modified
189576	Hospice Conditions of Participation (418.52(a)(3)	Modified

ICR Details

OMB Control No: 0938-1067	ICR Reference No: 201406-0938-002
Status: Historical Active	Previous ICR Reference No: 201011-0938-017
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Hospice Conditions of Participation (CMS-10277)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/24/2014
	Date Received in OIRA: 06/23/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	36 Months From Approved
Responses	19,284,489	0	0
Time Burden (Hours)	3,242,280	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The CoPs and accompanying requirements specified in the regulations are used by Federal or State surveyors as a basis for determining whether a hospice qualifies for approval or re-approval under Medicare. CMS and the healthcare industry believe that the availability to the hospice of the type of records and general content of records, which this regulation specifies, is standard medical practice, and is necessary in order to ensure the well-being and safety of patients and professional treatment accountability.

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Authorizing Statute(s): US Code: 42 USC 1395x Name of Law: Hospice Care; Hospice Program
   PL: Pub.L. 97 - 248 122 Name of Law: Tax Equity & Fiscal Responsibility Act
   PL: Pub.L. 101 - 239 6005(b) Name of Law: Omnibus Reconciliation Act of 1989
   PL: Pub.L. 105 - 33 Title IV, Chapter 4 Name of Law: BBA of 1997
   PL: Pub.L. 108 - 173 946 Name of Law: Medicare Prescription Drug, Improvement, & Modernization Act of 2003
  

Citations for New Statutory Requirements: US Code: 42 USC 1395x Name of Law: Hospice Care; Hospice Program

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 71617	11/29/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 31335	06/02/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 26

IC Title	Form No.	Form Name
Hospice Conditions of Participation 418.100(e)
Hospice Conditions of Participation 418.110(m)
Hospice Conditions of Participation 418.58 Phase 1
Hospice Condition of Participation 418.58 Phase 2 data entry
Hospice Conditions of Participation (418.52(a)(3)
Hospice Conditions of Participation 418.56(b) and (c)
Hospice Conditions of Participation 418.76(b)(c) and (d)
Hospice Conditions of Participation 418.78(a)(c)(d) and (e)
Hospice Conditions of Participation 418.106(a) and (e)
Hospice Conditions of Participation 418.110(n) training
Hospice Conditions of Participation (418.110 (n) new hospice program
Hospice Conditions of Participation 418.112(e)(3)
Hospice Conditions of Participation 418.114 (d)
Hospice Conditions of Participation 418.114 (b)
Hospice Conditions of Participation 418.22(b)(3)
Hospice Condition of Participation (418.22(b)(4) and (b)(5)
Hospice Conditions of Participation 418.22(b)(4)
Hospice Condtions of Participation 418.52(a)
Hospice Conditons of Participation 418.24 develop election form
Hospice Conditions of Participation 418.108(c)(1)
Hospice Conditions of Participation 418.58 Phase 2 aggregate/data analysis
Hospice Conditions of Participation 418.58 Phase 3
Hospice Conditions of Participation 418.28 explain revocation form
Hospice Conditions of Participation 418.24 explain election form
Hospice Conditions of Participation 418.28 develop revocation form
Hospice Conditions of Participation 418.52(b)

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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	19,284,489	0	0	17,061,295	0	2,223,194
Annual Time Burden (Hours)	3,242,280	0	0	1,882,066	0	1,360,214
Annual Cost Burden (Dollars)	0	0	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The 1,907,624 hour increase is due to three main factors. First, the number of Medicare-certified hospices has increased by 36 percent, from 2,872 to 3,897. Second, the number of patients receiving hospice services has increased by 77 percent, from 869,201 to 1,535,919. Third, the burden hours previously accounted for in OMB control number 0938-0302 have been updated and moved into this package in order to consolidate all hospice PRA burdens into a single package.

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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]? 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

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Common Form ICR:  No

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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: 06/23/2014

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