Hospice Conditions of Participation (CMS-10277)

Forms and Documents

Document Name	Status
CMS-10277 Supporting_Statement_Part_A 10-29-2019 clean.docx Supporting Statement A	2019-11-20

IC Document Collections

IC ID	Document Title	Status
233175	Hospital Conditions of Participation 418.106(e)	Removed
233171	Hospital Conditions of Participation 418.112(c)	Removed
230612	Hospice Conditions of Participation 418.108(c)(3)	Unchanged
230608	Hospice Conditions of Participation 418.110(n) documentation	Unchanged
211892	Hospice Conditions of Participation 418.58 Phase 3	Unchanged
211891	Hospice Conditions of Participation 418.58 Phase 2 aggregate/data analysis	Unchanged
211890	Hospice Condition of Participation 418.58 Phase 2 data entry	Unchanged
211889	Hospice Conditions of Participation 418.58 Phase 1	Unchanged
211888	Hospice Conditions of Participation 418.108(c)	Unchanged
211887	Hospice Conditions of Participation 418.110(m)	Unchanged
211886	Hospice Conditions of Participation 418.100(e)	Unchanged
211885	Hospice Conditions of Participation 418.52(b)	Unchanged
211884	Hospice Condtions of Participation 418.52(a)	Unchanged
211883	Hospice Conditions of Participation 418.28 develop revocation form	Unchanged
211882	Hospice Conditions of Participation 418.24 explain election form	Unchanged
211881	Hospice Conditions of Participation 418.28 explain revocation form	Unchanged
211880	Hospice Conditons of Participation 418.24 develop election form	Unchanged
195470	Hospice Conditions of Participation 418.22(b)	Unchanged
195469	Hospice Condition of Participation (418.22(b)(4) and (b)(5)	Unchanged
195468	Hospice Conditions of Participation 418.22(b)(3)	Unchanged
189585	Hospice Conditions of Participation 418.114 (b)	Unchanged
189584	Hospice Conditions of Participation 418.114 (d)	Unchanged
189583	Hospice Conditions of Participation 418.112(e)(3)	Unchanged
189582	Hospice Conditions of Participation (418.110 (n) new hospice training program	Unchanged
189581	Hospice Conditions of Participation 418.110(n) training	Unchanged
189580	Hospice Conditions of Participation 418.106 (e)	Unchanged
189579	Hospice Conditions of Participation 418.78(a)(c)(d) and (e)	Unchanged
189578	Hospice Conditions of Participation 418.76(c) and (d)	Unchanged
189577	Hospice Conditions of Participation 418.56(b) and (c)	Unchanged
189576	Hospice Conditions of Participation (418.52(a)(3)	Unchanged

ICR Details

OMB Control No: 0938-1067	ICR Reference No: 201911-0938-003
Status: Active	Previous ICR Reference No: 201809-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Hospice Conditions of Participation (CMS-10277)
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: 11/29/2019
	Date Received in OIRA: 11/20/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2022	36 Months From Approved	08/31/2021
Responses	17,807,870	0	20,992,646
Time Burden (Hours)	3,484,763	0	3,749,351
Cost Burden (Dollars)	0	0	0

---

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.

---

Authorizing Statute(s): 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
   US Code: 42 USC 1395x Name of Law: Hospice Care; Hospice Program
   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

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AT23	Final or interim final rulemaking	84 FR 51732	09/30/2019

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 28

IC Title	Form No.	Form Name
Hospice Conditions of Participation 418.100(e)
Hospice Conditions of Participation 418.110(m)
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(c) and (d)
Hospice Conditions of Participation 418.78(a)(c)(d) and (e)
Hospice Conditions of Participation 418.106 (e)
Hospice Conditions of Participation 418.110(n) training
Hospice Conditions of Participation (418.110 (n) new hospice training program
Hospice Conditions of Participation 418.112(e)(3)
Hospital Conditions of Participation 418.112(c)
Hospital Conditions of Participation 418.106(e)
Hospice Conditions of Participation 418.114 (d)
Hospice Conditions of Participation 418.114 (b)
Hospice Conditions of Participation 418.58 Phase 1
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)
Hospice Condtions of Participation 418.52(a)
Hospice Conditons of Participation 418.24 develop election form
Hospice Conditions of Participation 418.108(c)
Hospice Conditions of Participation 418.58 Phase 2 aggregate/data analysis
Hospice Conditions of Participation 418.58 Phase 3
Hospice Conditions of Participation 418.110(n) documentation
Hospice Conditions of Participation 418.108(c)(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)

---

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	17,807,870	20,992,646	0	-3,184,776	0	0
Annual Time Burden (Hours)	3,484,763	3,749,351	0	-264,588	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: Due to several regulatory provisions that were ultimately not finalized in 84 FR 51732 (specifically §§ 418.106(e) and 418.112(c)), the annual hourly burden for the information collection requirements for hospice CoPs has decreased from 3,525,020 hours to 3,484,763 hours.

---

Annual Cost to Federal Government: $0

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

---

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: 11/20/2019

---