Pre-Claim Review Demonstration for Inpatient Rehabilitation Facility Services (CMS-10765)

Forms and Documents

Document Name	Status
Form CMS-10765 Review Choice Demonstration for Inpatient Rehabilitation Facility Services Form and Instruction	Modified
CMS-10765 - Supporting Statement.docx Supporting Statement A	2025-07-31
CMS-10765 - Attachment A - Response to Comments - 60-day).docx Supplementary Document	2025-07-31

IC Document Collections

IC ID	Document Title	Status
249216	Review Choice Demonstration for Inpatient Rehabilitation Facility Services Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1420	ICR Reference No: 202507-0938-027
Status: Received in OIRA	Previous ICR Reference No: 202109-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: CPI - 10765
Title: Pre-Claim Review Demonstration for Inpatient Rehabilitation Facility Services (CMS-10765)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/31/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	237,419	0
Time Burden (Hours)	120,317	0
Cost Burden (Dollars)	7,896,556	0

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Abstract: The Centers for Medicare & Medicaid Services (CMS) is requesting the Office of Management and Budget (OMB) approval for the Review Choice Demonstration for Inpatient Rehabilitation Facility (IRF) Services. This demonstration will assist in developing improved procedures for the identification, investigation, and prosecution of potential Medicare fraud. By ensuring that payments for IRF services are appropriate through either pre-claim or postpayment review, this demonstration also works toward the prevention and identification of potential fraud, waste, and abuse, as well as protecting the Medicare Trust Funds from improper payments while reducing Medicare appeals. CMS proposes performing the demonstration in Alabama, Pennsylvania, Texas, and California, as well as IRFs in any state that bill to the Medicare Administrative Contractor (MAC) jurisdictions JJ, JL, JH, and JE.

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Authorizing Statute(s): US Code: 42 USC 602 Name of Law: Social Security Laws
  

Citations for New Statutory Requirements: US Code: 42 USC 402(a)(1)(J) Name of Law: Social Security Act

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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:
	89 FR 102149	12/17/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 27539	06/27/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Review Choice Demonstration for Inpatient Rehabilitation Facility Services	CMS-10765	Review Choice Demonstration for Inpatient Rehabilitation Facility Services

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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	237,419	0	0	0	57,509	179,910
Annual Time Burden (Hours)	120,317	0	0	0	28,784	91,533
Annual Cost Burden (Dollars)	7,896,556	0	0	0	1,912,749	5,983,807

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: Burden hours have increased due to the change in the number of IRFs which increased from 526 to 536. Overall burden hours increased from 91,533 to 120,317 hours. Costs have also increased as a result of the change in IRFs from $3,144,909 to $4,922,031 for all states in the demonstration.

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Annual Cost to Federal Government: $900,000

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? 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: 07/31/2025

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