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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
[Medicaid] GenIC #84 (New): PACE Medicaid Capitation Rate Setting Guide
Agency IC Tracking Number:
CMCS
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
PACE Medicaid Capitation Rate Setting Guide.pdf
Yes
No
Printable Only
Instruction
PACE Medicaid Capitation Rate Setting Guide_Appendix A.pdf
Yes
No
Printable Only
Form
Appendix B
PACE AWOP & Rate Package Submission Cover Sheet
PACE Medicaid Capitation Rate Setting Guide Appendix B (2024 version 3).pdf
Yes
Yes
Fillable Fileable
Instruction
PACE Medicaid Capitation Rate Setting Guide - AWOP Checklist FAQ .pdf
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
34
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
34
0
34
0
0
0
Annual IC Time Burden (Hours)
17
0
17
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Response to Public Comments
CMS response to comments received on #84 0938-1148.docx
01/28/2025
Comment (WelbeHealth)
m4x-0t6n-rjb7 - Comment.pdf
01/28/2025
Comment (National PACE Association)
m4x-6hhp-7788 - Comment.pdf
01/28/2025
Generic Supporting Statement
GenIC 84 - Generic Supporting Statement (2024 version 11).docx
01/28/2025
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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