Hospital Wage Index Occupational Mix Survey(CMS-10079)

Forms and Documents

Document Name	Status
Form CMS-10079 Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64 Form and Instruction	Modified
CMS-10079_Supporting_Statement_A - IPPS-b.docx Supporting Statement A	2019-09-11

IC Document Collections

IC ID	Document Title	Status
8747	Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64 Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0907	ICR Reference No: 201909-0938-007
Status: Active	Previous ICR Reference No: 201512-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: CMS-10079
Title: Hospital Wage Index Occupational Mix Survey(CMS-10079)
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 with change	Conclusion Date: 10/18/2019
	Date Received in OIRA: 09/12/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2022	36 Months From Approved	10/31/2019
Responses	3,300	0	3,400
Time Burden (Hours)	1,584,000	0	1,632,000
Cost Burden (Dollars)	0	0	0

---

Abstract: Section 304 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 requires CMS to collect wage data on hospital employees by occupational category, at least once every 3 years, in order to construct an occupational mix adjustment to the wage index. CMS first collected occupational mix data in 2003 for the FY 2005 wage index and a subsequent collection of occupational mix data was performed in 2006 for the FY 2007 and FY 2008 wage index. In response to industry comments suggesting ways to improve the occupational mix survey, CMS has revised the 2007/2008 survey that was used to calculate the FY 2010 wage index. We are revising the 2007/2008 survey to collect for a 12- month period (that is, from pay periods ending between January 1, 2010 and December 31, 2010). The revised occupational mix survey will be used to adjust the FY 2013 wage index.

---

Authorizing Statute(s): US Code: 18 USC 1886(d)(3)(E) Name of Law: Payments to inpatient hospitals for services.
   PL: Pub.L. 106 - 554 304 Name of Law: BIPA
  

Citations for New Statutory Requirements: None

---

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:
	84 FR 17166	04/24/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 47958	09/11/2019
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
Hospital Wage Index Occupational Mix Survey and Supporting Regulations in 42 CFR, Section 412.64	CMS-10079	Medicare Wage Index Occupational Mix Survey

---

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	3,300	3,400	0	0	-100	0
Annual Time Burden (Hours)	1,584,000	1,632,000	0	0	-48,000	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: Currently, there are approximately 3,300 short-term and acute care hospitals participating in the Medicare program which is a decrease of approximately 100 from the FY 2016 survey. We based this estimate on the number of hospitals that submitted wage index information for the FY 2019 IPPS rule. The 2019 survey will provide for the collection of hospital-specific wages and hours data for a 1-year reporting period (that is, payroll periods ending between January 1, 2019 and December 31, 2019). The estimated hospital burden hours for the 2019 Occupational Mix survey will decrease from 1,632,000 by 48,000 to 1,584,000 hours because we estimate fewer hospitals will be required to submit the occupational mix survey and we excluded the burden for the MACs since they are not respondents of this collection.

---

Annual Cost to Federal Government: $1,100,220

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]? No

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: 09/12/2019

---