PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program (CMS-10431)

Forms and Documents

Document Name	Status
Form CMS-10431 PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program Form and Instruction	Unchanged
CMS-10431 FY 2024 PCHQR Supporting Statement A 080323_clean.docx Supporting Statement A	2023-08-28

IC Document Collections

IC ID	Document Title	Status
202342	PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program Form and Instruction	Unchanged

ICR Details

OMB Control No: 0938-1175	ICR Reference No: 202308-0938-011
Status: Received in OIRA	Previous ICR Reference No: 202305-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: CCSQ
Title: PPS-exempt Cancer Hospital Quality Reporting (PCHQR) Program (CMS-10431)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/29/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2025
Responses	11	11
Time Burden (Hours)	109	3
Cost Burden (Dollars)	0	0

---

Abstract: Section 3005 of the Affordable Care Act authorizes the establishment of a quality reporting program for PPS-exempt cancer hospitals (PCHs). This is an update to the previously approved PCHQR Program PRA submission. In the FY 2024 IPPS/LTCH PPS final rule, we are adopting four new measures into the PCHQR Program measure set that would impact information collection: (1) the Documentation of Goals of Care Discussions Among Cancer Patients measure beginning with the FY 2026 program year, (2) the Facility Commitment to Health Equity measure beginning with the FY 2026 program year; (3) the Screening for Social Drivers of Health measure with voluntary reporting for the FY 2026 program year and mandatory reporting beginning with the FY 2027 program year; and (4) the Screen Positive Rate for Social Drivers of Health measure with voluntary reporting in the FY 2026 program year and mandatory reporting beginning with the FY 2027 program year.

---

Authorizing Statute(s): PL: Pub.L. 111 - 48 3005 Name of Law: Affordable Care Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV08	Final or interim final rulemaking	88 FR 58640	08/28/2023

---

Federal Register Notices & Comments

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
PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	CMS-10431, CMS-10431, CMS-10431, CMS-10431, CMS-10431	Oncology Care Measures Pop Sample application ,   Measure Exception Form ,   Oncology Cares Measures Paper Submission ,   Data Accuracy and Completeness Form ,   Notice of Participation

---

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	11	11	0	0	0	0
Annual Time Burden (Hours)	109	3	0	106	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: We previously estimated an annual burden of 0 hours and $0 cost for the 15 measures currently approved for the PCHQR program for the FY 2025 program year. For the four measures being finalized for the FY 2026 program year and subsequent years, we estimate a total burden increase of 109 hours at a cost of $2,452, including the impact of updated wage rates.

---

Annual Cost to Federal Government: $126,949

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]? 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? No

---

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: 08/29/2023

---