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	Modified
CMS-10431 PCHQR FY 2026 Supporting Statement A proposed rule_05192025_clean.docx Supporting Statement A	2025-06-02

IC Document Collections

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

ICR Details

OMB Control No: 0938-1175	ICR Reference No: 202505-0938-010
Status: Received in OIRA	Previous ICR Reference No: 202408-0938-029
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: 06/02/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	11/30/2027
Responses	11	11
Time Burden (Hours)	2	109
Cost Burden (Dollars)	0	0

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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 2025 IPPS/LTCH PPS proposed rule, we are proposing to adopt the Patient Safety Structural measure into the PCHQR Program measure set beginning with the CY 2025 reporting period/FY 2027 program year. For this measure, PCHs will be required to submit measure data via CDC’s NHSN. We are also proposing to modify the HCAHPS Survey beginning with the CY 2025 reporting period/FY 2027 program year.

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

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AV45	Proposed rulemaking	90 FR 18002	04/30/2025

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Federal Register Notices & Comments

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
PPS-exempt Cancer Hosptital Quality Reporitng (PCQR) Program	CMS-10431, CMS-10431, CMS-10431	Measure Exception Form ,   Data Accuracy and Completeness Form ,   Notice of Participation

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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	11	11	0	0	0	0
Annual Time Burden (Hours)	2	109	0	-107	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The proposal in the FY 2026 IPPS/LTCH PPS proposed rule to remove the Hospital Commitment to Health Equity measure beginning with the FY 2026 program year results in an annual burden decrease of 2 hours and $111. The proposals to remove the Screening for Social Drivers of Health and Screen Positive for Social Drivers of Health measures result in an annual burden decrease of 105 hours and $2,810. The aggregate decrease due to these policies and adjustments is 107 hours (-2 - 105) and $2,921 (-$111 - $2,810) as shown in Table 3. The burden hours have decreased from 109 to 2 hours.

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Annual Cost to Federal Government: $10,226,766

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

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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: 06/02/2025

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