National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) (CMS-10102)

Forms and Documents

Document Name	Status
Form CMS-10102 HCAHPS Survey (Patients) Form and Instruction	Modified
Form CMS-10102 HCAHPS Survey (Patients via Hospital Data Collection) Form and Instruction	Modified
CMS-10102 Response_to_Public_Comments 2-25-19.docx.doc Supplementary Document	2019-03-14
CMS-10102 Supporting Statement B 11-28-18.docx Supporting Statement B	2019-03-15
CMS-10102 SUPPORTING STATEMENT A- 11-28-18.docx Supporting Statement A	2019-03-15

IC Document Collections

IC ID	Document Title	Status
8843	HCAHPS Survey (Patients) Form and Instruction	Modified
202110	HCAHPS Survey (Patients via Hospital Data Collection) Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0981	ICR Reference No: 201903-0938-006
Status: Active	Previous ICR Reference No: 201807-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) (CMS-10102)
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: 05/06/2019
	Date Received in OIRA: 03/19/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2021	36 Months From Approved	11/30/2021
Responses	3,108,400	0	3,108,400
Time Burden (Hours)	379,290	0	417,990
Cost Burden (Dollars)	0	0	0

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Abstract: The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. While many hospitals collect information on patient satisfaction, there is no national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across all hospitals.

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Authorizing Statute(s): PL: Pub.L. 109 - 171 1886(b)(3)(B) Name of Law: Deficit Reduction Act of 2005
   PL: Pub.L. 111 - 148 3001 Name of Law: Affordable Care Act
   PL: Pub.L. 115 - 271 6104 Name of Law: SUPPORT Act
  

Citations for New Statutory Requirements: PL: Pub.L. 115 - 271 6104 Name of Law: SUPPORT Act

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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:
	83 FR 63648	12/11/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 9527	03/15/2019
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
HCAHPS Survey (Patients via Hospital Data Collection)	CMS-10102, CMS-10102, CMS-10102	HCAHPS Survey Instrument (Mail) and Supporting Materials ,   HCAHPS Survey Instrument (Telephone Script) ,   HCAHPS Survey Instrument (AVIR Script)
HCAHPS Survey (Patients)	CMS-10102, CMS-10102, CMS-10102	HCAHPS Survey Instrument (Telephone Script) ,   HCAHPS Survey Instrument (AVIR Script) ,   HCAHPS Survey Instrument (Mail) and Supporting Materials

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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	3,108,400	3,108,400	0	0	0	0
Annual Time Burden (Hours)	379,290	417,990	-38,700	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: CMS will remove the three Communication About Pain items (items 12, 13 and 14) from the HCAHPS Survey effective with October 2019 discharges. Removal of these three items from the HCAHPS Survey reduces burden to patients, as shown above in section 12, but has no effect on hospitals, as shown in section 13. The burden hours have decreased from 417,990 to 379,290.

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Annual Cost to Federal Government: $3,325,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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

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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: 03/19/2019

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