(CMS-10409) Long Term Care Hospital (LCTH) Quality Reporting Program

Forms and Documents

Document Name	Status
Form CMS-10409 Pressure Ulcer Submissions Form and Instruction	Modified
CMS-10409 Supporting Statement Part A _508C.docx Supporting Statement A	2016-05-31

IC Document Collections

IC ID	Document Title	Status
201171	Pressure Ulcer Submissions Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1163	ICR Reference No: 201605-0938-020
Status: Historical Active	Previous ICR Reference No: 201304-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: 19270
Title: (CMS-10409) Long Term Care Hospital (LCTH) Quality Reporting Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/06/2017
	Date Received in OIRA: 05/31/2016
Terms of Clearance: This information collection request is approved as an extension, consistent with CMS' categorization in ROCIS and discussion in the supporting statement. However, OMB notes that the burden change for this collection was erroneously reported in ROCIS as a program change. In future submissions of all information collection requests, CMS needs to be mindful to report burden changes associated with extensions in the adjustment category. Failure to do so can result in it being sent back to the agency as "improperly submitted." OMB further notes that CMS states it plans to display the expiration date associated with this collection. The expiration date and OMB control number must be displayed on all paper and electronic versions of the collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved	03/31/2017
Responses	405,270	0	403,988
Time Burden (Hours)	392,861	0	212,160
Cost Burden (Dollars)	0	0	0

---

Abstract: Section 3004 of The Affordable Care Act authorizes the establishment of a new quality reporting program for Long Term Care Hospitals (LTCHs). The LTCH Quality Reporting Program (QRP) was implemented in section VII.C. of the FY 2012 IPPS/LTCH PPS final rule (76 FR 51743 through 51756) pursuant to Section 3004 of the Patient Protection and Affordable Care Act of 2010. Beginning in FY 2014, LTCHs that fail to submit quality measures data to CMS on three quality measures (NQF #0678, NQF #0138, NQF #0139), may be subject to a 2 percentage point reduction in their annual payment update. In the FY 2013 IPPS/LTCH PPS final rule (76 FR 53614 through 53637 and 53667 through 53672), CMS retained three measures and adopted two new measures (NQF #0680 and NQF #0431) for the FY 2016 payment determination. In the FY 2014 IPPS/LTCH PPS final rule (78 FR 50853 through 50887 and 50959 through 50964), CMS retained five measures and adopted two additional measures (NQF #1716 and NQF #1717) for the FY 2017 payment determination. In the FY 2015 IPPS/LTCH PPS final rule (79 FR 50286 through 50318 and 50348 through 50349) , CMS retained seven measures and adopted one additional measure (NQF #2512) for the FY 2017 payment determination and four additional measures (application of NQF #0674, NQF #2631, NQF #2632, and non-NQF endorsed NHSN VAE) for the FY 2018 payment determination. In the FY 2016 IPPS/LTCH PPS final rule (80 FR 49723 through 49756 and 49764 through 49766), CMS retained twelve measures and adopted 3 measures to meet the requirements of the IMPACT Act (NQF #0678, application of NQF #2631, and application of NQF #0674) for FY 2018 payment determination and 1 measure (NQF #2512) to reflect NQF endorsement status for FY 2018 payment determination.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 3004 Name of Law: Quality reporting for LTCHs, inpatient rehabilitation hospitals, and hospice programs
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 3004 Name of Law: Quality reporting for LTCHs, inpatient rehabilitation hospitals, and hospice programs

---

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 12904	03/11/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 30309	05/16/2016
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
Pressure Ulcer Submissions	CMS-10409, CMS-10409, CMS-10409, CMS-10409	LTCH Care Data Set Admissions ,   LTCH Care Data Set Expired ,   LTCH Care Data Set Planned Discharge ,   LTCH Care Data Set Unplanned Discharge

---

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	405,270	403,988	0	1,282	0	0
Annual Time Burden (Hours)	392,861	212,160	0	180,701	0	0
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: No

Burden Reduction Due to:

Short Statement: The number of Medicare-certified LTCHs have declined from 442 to 432; however, discharges remained steady (202,050 vs. 202,635). The annual burden hours increased from 212,160 to 392,861. Second, the number of questions increased from V2.01 to V3.00 due to the addition of new measures.

---

Annual Cost to Federal Government: $3,135,322

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

---

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: 05/31/2016

---