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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-0920
ICR Reference No:
202205-0938-015
Status:
Historical Active
Previous ICR Reference No:
202011-0938-002
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CMCS
Title:
Medicaid Managed Care and Supporting Regulations (CMS-10108)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/28/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/07/2022
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2025
36 Months From Approved
06/30/2024
Responses
13,742,805
0
13,742,723
Time Burden (Hours)
1,682,411
0
1,682,083
Cost Burden (Dollars)
0
0
0
Abstract:
These information collections requirements implement regulations that allow states greater flexibility to implement mandatory managed care programs, implement new beneficiary protections, and eliminate certain requirements viewed by state agencies as impediments to the growth of managed care programs. Information collected includes information about managed care programs, grievances and appeals, enrollment broker contracts, and managed care organizations capacity to provide health care services.
Authorizing Statute(s):
US Code:
42 USC 438.50
Name of Law: State Plan Requirements
US Code:
42 USC 438.56
Name of Law: Disenrollment: Requirements and limitations
US Code:
42 USC 438.102
Name of Law: Provider-enrollee communications
US Code:
42 USC 438.114
Name of Law: Emergency and post-stabilization services
US Code:
42 USC 438.202
Name of Law: State responsibilities
US Code:
42 USC 438.204
Name of Law: Elements of State quality strategies
US Code:
42 USC 438.8
Name of Law: Provisions that apply to PIHPs and PAHPs
US Code:
42 USC 438.206
Name of Law: Availablity of services
US Code:
42 USC 438.207
Name of Law: Assurances of adequate capacity and services
US Code:
42 USC 438.242
Name of Law: Health information systems
US Code:
42 USC 438.402
Name of Law: General requirements
US Code:
42 USC 438.240
Name of Law: Quality assessment and performance improvement program
US Code:
42 USC 438.404
Name of Law: Notice of Action
US Code:
42 USC 438.406
Name of Law: Handling of grievances and appeals
US Code:
42 USC 438.410
Name of Law: Expedited resolution of appeals
US Code:
42 USC 438.414
Name of Law: Information about the grievance system to providers
US Code:
42 USC 438.416
Name of Law: Record keeping and reporting requirements
US Code:
42 USC 438.604
Name of Law: Data that must be certified
US Code:
42 USC 438.710
Name of Law: Due process: Notice of sanction and pre-determination hearing
US Code:
42 USC 438.408
Name of Law: Resolution and notification: Grievances and appeals
US Code:
42 USC 438.722
Name of Law: Disenrollment during termination hearing process
US Code:
42 USC 438.724
Name of Law: Notice to CMS
US Code:
42 USC 438.810
Name of Law: Expenditures for enrollment broker services
US Code:
42 USC 438.10
Name of Law: Information Requirements
US Code:
42 USC 438.6
Name of Law: Contract Requirements
US Code:
42 USC 438.12
Name of Law: Provider Discrimination prohibited
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
87 FR 12458
03/04/2022
30-day Notice:
Federal Register Citation:
Citation Date:
87 FR 28830
05/11/2022
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
2
IC Title
Form No.
Form Name
Medicaid Managed Care Regulations (Private Sector) 42 CFR 438.8, 438.10, 438.12, 438.102, 438.207, 438.208, 438.210, 438.236, 438.240, 438.242, 438.404, and 438.416
Medicaid Managed Care Regulations (States) 42 CFR 438.6, 438.10, 438.50, 438.202, 438.722, 438.724, and 438.810
CMS-10108, CMS-10108, CMS-10108
Managed Care Program Annual Report (MCPAR)
,
MLR Reporting Tool
,
Network Adequacy and Access Assurances Tool
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
13,742,805
13,742,723
0
82
0
0
Annual Time Burden (Hours)
1,682,411
1,682,083
0
328
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:
Changing Regulations
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
The burden has increased slightly as two new burden estimates were added. These burden estimates accommodate the use of reporting templates for existing reporting requirements at 42 CFR 438.207(d) for network adequacy and access and 438.74 for medical loss ratio. The resulting increase is 328 hours.
Annual Cost to Federal Government:
$59,561,736
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
Agency Contact:
Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov
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:
06/07/2022
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