View Information Collection Request (ICR) Package

OMB Control No: 0938-0935	ICR Reference No: 201111-0938-003
Status: Historical Active	Previous ICR Reference No: 201009-0938-017
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Advantage Application - Part C and 1876 Cost Plan Expansion Application regulations under 42 CFR 422 subpart K & 417.400
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/09/2012
	Date Received in OIRA: 11/07/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	36 Months From Approved	01/31/2012
Responses	378	0	870
Time Burden (Hours)	13,296	0	15,696
Cost Burden (Dollars)	0	0	0

Abstract: In order to provide health benefits to Medicare beneficiaries under the Medicare Advantage Program and/or the 1876 Cost Plan, applicant must meet regulatory requirements to enter into a contract with CMS, or to continue to contract with CMS. The revised Part C application is created to capture the applicants' information.

Authorizing Statute(s): PL: Pub.L. 108 - 173 1857 Name of Law: Medicare Advantage
   PL: Pub.L. 110 - 275 161 Name of Law: Provisions relating to Part C
   US Code: 42 USC 1395mm

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:
	76 FR 62414	10/07/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 38655	07/01/2011
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 Applications and 1876 Cost Plan Expansion Application (CY 2012)	CMS-10237, CMS-10237, CMS-10237, CMS-10237	, , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	378	870	-492
Annual Time Burden (Hours)	13,296	15,696	-2,400
Annual Cost Burden (Dollars)	0	0	0

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Overall Decrease Burden of Hours: The decrease in the overall burden hours is due to the decrease in the expected number of respondents. The number of SNP-only request will decrease because CMS has made an internal decision to not have all MA contractors that are currently offering a SNP product to complete and submit a SNP proposal. Only the MA organizations currently offering a SNP that requires re-approval under the NCQA SNP Approval process would be required to submit the Model of Care written narrative and Model of Care Matrix Upload Document portion of the SNP Proposal. Increase Burden Hours per application: An additional 5 hours of burden was added to the Initial application. This increase stems from an internal assessment of the application materials. For CY2013, CMS added three (3) new templates to clarify information that is being requested and to reduce confusion amongst applicants and reviewers. CMS also added three (3) new attestations. These attestations stems from regulatory changes at 42 CFR 422 subpart K.

Annual Cost to Federal Government: $948,400

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]? 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? Uncollected

Agency Contact: William Parham 4107864669

View ICR - OIRA Conclusion