Long Term Care Hospital (LCTH) Quality Reporting Program

Forms and Documents

Document Name	Status
Form CMS-10409 Pressure Ulcer Submissions Form and Instruction	Modified
Note to OMB December 19.docx Supplementary Document	2013-04-12
CMSMemo_Meas0678.pdf Supplementary Document	2013-04-12
Burden Calculations LTCH clean 12 19 12.docx Supplementary Document	2013-04-12
Appendix A LTCH CARE Item Matrix_V2 00_20121207.xlsx Supplementary Document	2013-04-12
Appendix B Change Table for PRA_V2 00_20121207.docx Supplementary Document	2013-04-12
CMS-10409 Supporting Statement A clean 1.28.12.docx Supporting Statement A	2013-04-12

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: 201304-0938-004
Status: Historical Active	Previous ICR Reference No: 201208-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No: 19270
Title: Long Term Care Hospital (LCTH) Quality Reporting Program
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: 06/10/2013
	Date Received in OIRA: 04/12/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2016	36 Months From Approved	06/30/2013
Responses	403,988	0	263,000
Time Burden (Hours)	212,160	0	43,500
Cost Burden (Dollars)	0	0	0

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Abstract: Section 3004 of the Affordable Care Act authorized the establishment of a new quality reporting program for Long Term Care Hospitals (LTCHs). Section 3004 of the ACA 3004 states that beginning in FY 2014, LTCHs that fail to submit quality measures data to CMS, may be subject to a 2 percentage point reduction in their annual update to the standard Federal rate for discharges occurring during a rate year. CMS implemented The LTCH Quality Reporting Program (LTCHQR Program) in the FY 2012 IPPS/LTCH PPS final rule (76 FR 51743 through 51756) pursuant to Section 3004 of the Affordable Care Act. In this rule, CMS set forth the initial framework for the LTCHQR Program and established the LTCH providers would begin to report quality data on October 1, 2012. The Long-Term Care Hospital (LTCH) Continuity Assessment Record & Evaluation (CARE) Data Set (LTCH CARE Data Set) was developed specifically for use in LTCHs for data collection of quality measure data. The first quality measure data items that were added to the LTCH CARE Data Set were the NQF # 0678 pressure ulcer measure items. In the FY 2013 IPPS/LTCH PPS final rule (76 FR 51743 through 51756), CMS retained the three measures that had been previously adopted in the FY 2012 rule and adopted two new measures (NQF #0680 and NQF #0431) for the FY 2016 payment determination. The new NQF #0680 measure will be collected using the LTCH CARE Data Set. Therefore, the LTCH CARE Data Set must be revised to include additional data items for this new measure. Also, in the FY 2013 IPPS/PPS LTCH Final Rule, it was decided that other revision to the LTCH CARE Data set would be necessary. For a full list of these changes refer to Section 1 of the Supporting Statement A.

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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

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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 7433	02/01/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 21955	04/12/2013
Did the Agency receive public comments on this ICR? No

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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

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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	403,988	263,000	140,988	0	0	0
Annual Time Burden (Hours)	212,160	43,500	168,660	0	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: No

Burden Reduction Due to:

Short Statement: There will be an increase in the time and wage burden to LTCHs for the completion of the LTCH CARE DATA Set because of several factors: (1) the increase in the number of LTCH discharges and number of LTCHS in the U.S. in the burden calculation causes an increase in the total number; (2) the addition of a new measure will cause an increase in the time that it takes to complete the LTCH CARE Data Set.; (3) the LTCHQR Program went live on 10/01/12 and after getting feedback from LTCHs about the time it takes to complete the LTCH CARE Data Set on their patients, we reviewed our prior burden calculation. We realize that we had under-estimated the burden estimate for the LTCH CARE Data Set. To correct this, we added additional clinical staff and administrative staff time to our current burden calculation. This has caused an increase in the total burden calculation.

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Annual Cost to Federal Government: $2,750,000

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: 04/12/2013

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