Hospice Conditions of Participation (CMS-10277)

OMB Control No: 0938-1067	ICR Reference No: 201803-0938-001
Status: Historical Active	Previous ICR Reference No: 201406-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Hospice Conditions of Participation (CMS-10277)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/14/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/16/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2021	36 Months From Approved
Responses	20,992,646	0	0
Time Burden (Hours)	3,749,351	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The CoPs and accompanying requirements specified in the regulations are used by Federal or State surveyors as a basis for determining whether a hospice qualifies for approval or re-approval under Medicare. CMS and the healthcare industry believe that the availability to the hospice of the type of records and general content of records, which this regulation specifies, is standard medical practice, and is necessary in order to ensure the well-being and safety of patients and professional treatment accountability.

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Authorizing Statute(s): US Code: 42 USC 1395x Name of Law: Hospice Care; Hospice Program    PL: Pub.L. 97 - 248 122 Name of Law: Tax Equity & Fiscal Responsibility Act    PL: Pub.L. 101 - 239 6005(b) Name of Law: Omnibus Reconciliation Act of 1989    PL: Pub.L. 105 - 33 Title IV, Chapter 4 Name of Law: BBA of 1997    PL: Pub.L. 108 - 173 946 Name of Law: Medicare Prescription Drug, Improvement, & Modernization Act of 2003

Citations for New Statutory Requirements: US Code: 42 USC 1395x Name of Law: Hospice Care; Hospice Program

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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:
	82 FR 58612	12/13/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 7479	02/21/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 28

IC Title Form No. Form Name Hospice Conditions of Participation 418.114 (d) Hospice Conditions of Participation 418.114 (b) Hospice Conditions of Participation 418.22(b)(3) Hospice Condition of Participation (418.22(b)(4) and (b)(5) Hospice Conditions of Participation 418.22(b) Hospice Condtions of Participation 418.52(a) Hospice Conditons of Participation 418.24 develop election form Hospice Conditions of Participation 418.108(c) Hospice Conditions of Participation 418.58 Phase 2 aggregate/data analysis Hospice Conditions of Participation 418.58 Phase 3 Hospice Conditions of Participation 418.110(n) documentation Hospice Conditions of Participation 418.108(c)(3) Hospice Conditions of Participation 418.28 explain revocation form Hospice Conditions of Participation 418.24 explain election form Hospice Conditions of Participation 418.28 develop revocation form Hospice Conditions of Participation 418.52(b) Hospice Conditions of Participation 418.100(e) Hospice Conditions of Participation 418.110(m) Hospice Conditions of Participation 418.58 Phase 1 Hospice Condition of Participation 418.58 Phase 2 data entry Hospice Conditions of Participation (418.52(a)(3) Hospice Conditions of Participation 418.56(b) and (c) Hospice Conditions of Participation 418.76(c) and (d) Hospice Conditions of Participation 418.78(a)(c)(d) and (e) Hospice Conditions of Participation 418.106(a) and (e) Hospice Conditions of Participation 418.110(n) training Hospice Conditions of Participation (418.110 (n) new hospice training program Hospice Conditions of Participation 418.112(e)(3)

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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	20,992,646	0	0	18,128	1,690,029	19,284,489
Annual Time Burden (Hours)	3,749,351	0	0	1,511	505,560	3,242,280
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: The total annual hourly burden for the information collection requirements is estimated to be 3,749,351 hours. The 507,071 hours hour increase is due to two main factors. First, the number of Medicare-certified hospices has increased by 576 hospices, from 3,897 to 4,473. Second, the number of patients receiving hospice services has increased 51,608 patients, from 1, 535,919 to 1,587,527 (1,428,775 Medicare Beneficiaries and 158,752 non-Medicare Beneficiaries).

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Annual Cost to Federal Government: $0

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? Uncollected

Agency Contact: Denise King 410 786-1013 [email protected]

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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: 03/16/2018

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