Quality improvement is a major initiative for the Centers for Medicare and Medicaid Services (CMS). With the passing of the Affordable Care Act in March 2010, there is an increased interest in providing quality healthcare for Medicare and Medicaid beneficiaries. Thus, it is imperative that CMS collect data for measuring and evaluating the quality of care provided to PACE participants and to establish PACE quality strategies and benchmarks for PACE organizations.
This request is for requiring PACE organizations to enter Level I and Level II data into the CMS's Health Plan Monitoring System (HPMS) (an electronic data entry system) for purpose of analyzing quality of care.
Once PACE organizations are entering Level I and Level II data into HPMS, CMS will be able to analyze results for each organization and the PACE program as a whole. We can then use that analysis to develop a quality improvement strategy for PACE.
There are several data quality changes (see Appendix A for a list of this iteration’s quality data) which have no impact on our currently approved burden estimates. The changes were made to mimic industry terminology and standards. More specifically, there was a name change from Prospective enrollees to Denials, there was no change in the intent, however we HPMS to capture the same information. For Census, this information was collected in the HPMS but was not listed under as a certain individual title and therefore the technology within the HPMS system allowed for a title to be created in the system for the number POs in a PO (which is called census). While Immunizations has always been collected, it was inadvertently omitted from the currently approved information collection request. Unusual incidents and Reporting requirements/all reporting is not a new requirement, it’s the old terminology relating to Level I and Level II as Unusual incidents.
Additionally, we are:
(1) Adjusting our estimated number of respondents from 100 POs to 120 POs.
(2) We are adding three (Falls, Falls with Injury and Pressure Ulcer Prevalence) PACE Quality measures adopted from the NQF.
(3) While the number of data categories is unchanged, this iteration adds 50 Level I entries and 85 Level II entries. The adjustment is in response to public comment.
(4) Based on previous and current public comments we are adjusting Level I response time from 0.25 hr to 2.0 hr.
(5) Correcting our calculation for the number of responses which should amount to: # POs x annual frequency of reporting.
(6) We propose to collect all PACE quality data into HPMS. Currently, Level I data is entered into HPMS as a narrative for each requirement. The change includes entering all PACE quality data collected in HPMS from a pick list/drop down selection format.
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:
(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;
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.
Form CMS-10525 Quality Measure(s) Data Entry
CMS-10525 - Supporting Statement A [rev 12-20-2016 by OSORA PRA].docx
Quality Measure(s) Data Entry