View Information Collection Request (ICR) Package
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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:
0938-1054
ICR Reference No:
200810-0938-009
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a)
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
12/24/2008
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/08/2008
Terms of Clearance:
This ICR is approved consistent with revised supporting statement and revised instruments, in response to public comments. Because the public specifically noted that it would have liked to have had the chance to comment on reporting requirements which CMS finalizes in its "technical specifications," CMS agrees to include the technical specifications document in the ICR package in the future and to make it available to the public during the public comment periods. ICR packages that do not contain this information and were not made available for public comment will be considered incomplete. CMS also understands that all burden-impacting changes--even technical changes like procedure and diagnosis codes that are revised annually--are subject to the PRA and require an opportunity for public comment before they are implemented. This includes changes that would require respondents to change their workflow processes or computer programs in order to accommodate those changes.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2011
36 Months From Approved
Responses
12,709
0
0
Time Burden (Hours)
286,944
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
CMS' regulatory authority to establish reporting requirements for Part C Medicare Advantage (MA) organizations is described in 42 CFR ?422.516 (a). It is noted that each MA organization must have an effective procedure to develop, compile, evaluate, and report to CMS, to its enrollees, and to the general public, at the times and in the manner that CMS requires, and while safeguarding the confidentiality of the doctor-patient relationship, statistics and other information with respect to the following: (1) The cost of its operations. (2) The patterns of utilization of its services. (3) The availability, accessibility, and acceptability of its services. (4) To the extent practical, developments in the health status of its enrollees. (5) Other matters that CMS may require. With both growth in the number of participating organizations and the types of plan "packages" available to Medicare beneficiaries, the need for more extensive, in depth, and effective monitoring has increased. Therefore, CMS is requesting a 3 year OMB approval of additional Part C data reporting.
Authorizing Statute(s):
PL:
Pub.L. 110 - 275 164
Name of Law: MIPPA
Citations for New Statutory Requirements:
PL: Pub.L. 110 - 275 164 Name of Law: MIPPA
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AP24
Final or interim final rulemaking
73 FR 54208
09/18/2008
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
73 FR 36329
06/26/2008
30-day Notice:
Federal Register Citation:
Citation Date:
73 FR 57631
10/03/2008
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a) - (CMS-10261)
CMS-10261, CMS-10261, CMS-10261
Attachment I - Part C Reporting Overview
,
Attachment III - Medicare Advantage Medical Utilization and Expenditure Experience
,
Medicare Part C Reporting Requirements
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
12,709
0
0
12,709
0
0
Annual Time Burden (Hours)
286,944
0
22,073
264,871
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:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
CMS has received many inquiries pertaining to the performance of Medicare Advantage Organizations (MAOs). CMS has not been able to address many of these inquiries because of an absence of data. CMS needs to initiate data collection in these and other areas that have been the subject of recent inquiries by both governmental and private groups in order to improve its performance monitoring of MAOs. In response to this, CMS has identified a set of 13 measures for collection beginning in 2009. CMS is requesting a three-year Office of Management and Budget (OMB) approval of the reporting of these measures from MAOs. MAOs will be required to collect these data beginning on January 1, 2009. The supporting statement provides more elaboration on the reasons that these reporting requirements are needed including statutory and regulatory requirements. However, some of the changes include: CMS included cost plans in its reporting requirements outlined in the Federal Register notice on June 26, 2008. After careful consideration, CMS has determined that because of the unique operation of cost plans, CMS will not require cost plans to comply with the following reporting requirements: benefit utilization; procedure frequency; and serious reportable adverse events. The other significant revisions to Part C reporting requirements are due to statutory and regulatory revisions that have occurred after June 26, 2008. Besides the 12 measures reported in the June 26, 2008 Federal Register Notice, in this notice, an additional measure has been added: Special Needs Plans (SNPs) Care Management. This measure was added because of Section 164 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires all SNPs to have an evidenced-based model of care with appropriate networks of providers and specialists. In addition, several measures , including agent commission structure, training and testing of agents, and plan oversight of agents, were revised as a result of MIPPA and the finalization of our regulation entitled, Medicare Program; Revisions to the Medicare Advantage and Prescription Drug Program" (CMS 4131-F)
Annual Cost to Federal Government:
$300,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Bonnie Harkless 4107865666
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:
10/08/2008
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