Inpatient Rehabilitation Assessment Instrument and Data Set for PPS for Inpatient Rehabilitation Facilities (CMS-10036)

Forms and Documents

Document Name	Status
Form CMS-10036 Inpatient Rehabilitation Facility - Patient Assessment Instrument Form and Instruction	Modified
CMS-10036-Supporting-Statement-A-10-17-22.docx Supporting Statement A	2022-10-17

IC Document Collections

IC ID	Document Title	Status
210555	Inpatient Rehabilitation Facility - Patient Assessment Instrument Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0842	ICR Reference No: 202210-0938-004
Status: Received in OIRA	Previous ICR Reference No: 202204-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: Inpatient Rehabilitation Assessment Instrument and Data Set for PPS for Inpatient Rehabilitation Facilities (CMS-10036)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/17/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2025
Responses	672,345	411,622
Time Burden (Hours)	1,187,475	727,198
Cost Burden (Dollars)	0	0

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Abstract: The Centers for Medicare & Medicaid Services (CMS) is requesting approval of revisions to the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) Version 4.1 that will be effective on October 1, 2024. On July 27, 2022 the Centers for Medicare & Medicaid Services (CMS) issued a final rule (87 FR 47038) which finalized proposed modifications to the collection of quality reporting data in the Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP). Per the final rule CMS will require IRFs to start collecting assessment data using IRF-PAI Version 4.1 for all IRF patients regardless of payer beginning October 1, 2024. The rule is available here: https://www.federalregister.gov/documents/2022/08/01/2022-16225/medicare-program-inpatient-rehabilitation-facility-prospective-payment-system-for-federal-fiscal CMS is asking for approval of the IRF-PAI Version 4.1, which will have an October 1, 2024 implementation date.

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Authorizing Statute(s): PL: Pub.L. 105 - 1 4421 Name of Law: Prospective Payment for Inpatient Rehab Hospital Services
   PL: Pub.L. 111 - 148 3004 Name of Law: Quality Reporting for Long-Term Care Hospitals, etc.
   US Code: 42 USC 1395ww(jX2)(d) Name of Law: Prospective Payment for Inpatient Rehab Services
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AU78	Final or interim final rulemaking	87 FR 47038	08/01/2022

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 20218	04/06/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 47038	08/01/2022
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
Inpatient Rehabilitation Facility - Patient Assessment Instrument	CMS-10036	IRF- PAI version 4.1

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ICR Summary of Burden

	Total Request	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	672,345	411,622	0	260,723	0	0
Annual Time Burden (Hours)	1,187,475	727,198	0	460,277	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is no change in the amount of time it will take to complete a single IRF PAI 4.1 as compared to the IRF PAI 4.0. The increase in burden is a result of collecting the IRF PAI 4.1 on all patients regardless of payer, which increases the total number of IRF PAI 4.1 assessments collected across all IRFs. Therefore, the burden will increase from 704,707 hours across all IRFs to a total of 1,187,475 hours beginning October 1, 2024.

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Annual Cost to Federal Government: $3,154,694

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.     Yes

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.     Yes

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? Yes

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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: 10/17/2022

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