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OMB Control No: 0938-1219	ICR Reference No: 201410-0938-001
Status: Historical Active	Previous ICR Reference No: 201308-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: 20261
Title: Medicaid Incentives for Prevention of Chronic Diseases Evaluation (CMS-10477)
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: 10/29/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/01/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	36 Months From Approved	01/31/2017
Responses	4,706	0	4,686
Time Burden (Hours)	2,236	0	1,836
Cost Burden (Dollars)	0	0	0

Abstract: Section 4108 (a) (1) of the 2010 Affordable Care Act (ACA) established the Medicaid Incentive for Prevention of Chronic Disease program (MIPCD). This national demonstration awarded 10 grants to states to implement programs that provide incentives to Medicaid beneficiaries of all ages who participate in prevention programs and demonstrate changes in health risk and outcomes, including the adoption of healthy behaviors. Programs address at least one of the following prevention goals: tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or in the case of a diabetic, improving the management of the condition. Programs are comprehensive, widely available, easily accessible, and based on relevant evidence-based research and resources. Under Section 4108 (d) of the Affordable Care Act, Health and Human Services Secretary through the Centers for Medicare and Medicaid Services (CMS) awarded a contract to Research Triangle Institute to conduct an independent assessment of these 10 State demonstration Grantees. This assessment will focus on evaluating:(A)the effect of the initiatives on the use of health care services by Medicaid beneficiaries participating in the program;(B)the extent to which special populations (adults with disabilities, adults with chronic illnesses, and children with special health care needs) are able to participate in the program; (C)the level of satisfaction of Medicaid beneficiaries with respect to the accessibility and quality of health care services provided through the program; and(D)the administrative costs incurred by State agencies that are responsible for administration of the program. To address these topics we will be conducting Site Visits, Stakeholder Interviews, Focus Groups, Beneficiary Survey and Administrative Cost Forms.

Authorizing Statute(s): PL: Pub.L. 111 - 148 4108 Name of Law: Affordable Care Act

Citations for New Statutory Requirements: PL: Pub.L. 111 - 148 4108 Name of Law: Affordable Care Act

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:
	79 FR 42018	07/18/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 57932	09/26/2014
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	4,706	4,686	20
Annual Time Burden (Hours)	2,236	1,836	400
Annual Cost Burden (Dollars)	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: The addition of the two Administrative Costs Forms adds two new collection instruments to this package. These forms increase the burden to include 20 more respondents; 400 more total burden hours. The new total burden associated with this information collection is 2,236 hours.

Annual Cost to Federal Government: $155,126

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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]? Yes

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: Denise King 410 786-1013 Denise.King@cms.hhs.gov

View ICR - OIRA Conclusion