View Information Collection Request (ICR) Package

OMB Control No: 0938-1152	ICR Reference No: 201410-0938-009
Status: Historical Active	Previous ICR Reference No: 201110-0938-012
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Collection of Encounter Data from Medicare Advantage Organizations (CMS-10340)
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: 11/24/2014
	Date Received in OIRA: 10/09/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	36 Months From Approved	12/31/2014
Responses	516,493,635	0	517,793,438
Time Burden (Hours)	34,433	0	34,520
Cost Burden (Dollars)	0	0	0

Abstract: Given the increased importance of the accuracy of our Medicare Advantage risk adjustment methodology, we amended ? 422.310 in August of 2008 to announce that CMS would collect data from MA organizations regarding each item and service provided to an MA plan enrollee. This would allow CMS to incorporate the Medicare Advantage utilization in the development of risk adjustment models for the Medicare Advantage program.

Authorizing Statute(s): US Code: 42 USC 1395w-23 Name of Law: Risk Adjusted Part C Payment
   US Code: 42 USC 1395w-23 Name of Law: Data Collection
   US Code: 42 USC 1395w-23 Name of Law: Risk Adjusted Part D Payment

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:
	79 FR 31336	06/02/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 53067	09/05/2014
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Collection of Encounter Data from Medicare Advantage Organizations	CMS-10340, CMS-10340, CMS-10340	, ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	516,493,635	517,793,438	-324,951	-974,852
Annual Time Burden (Hours)	34,433	34,520	-22	-65
Annual Cost Burden (Dollars)	0	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: Changing Forms

Short Statement: The number of respondents have been adjusted from 827 (currently approved) to 683 (revised). Also, various attachments have been added to this package. For instance, there is now a DME companion guide as the system now processes DME claims. The burden for DME is built into the cost of effort for a plan per year that is calculated in section 12 of this Supporting Statement, listed as $1,728.50. DME claims for encounter data is a smaller portion of Part B claims and therefore the process to create the data in the same format is reduced. The remaining attachments comprise the submitter application, and EDI agreement, for Medicare Advantage plans or third party submitters that wish to request to receive a Submitter Identification number from CMS. This submitter ID obtained from the application process allows either party to submit plan data to CMS. The application will be found on the CSSC Website under the "Enroll to Submit Encounter Data" under the each major category of the website. The additional documents are the individual sections of the actual application form that is to be completed by Medicare Advantage plans or third party submitters. Because the submitters must currently complete a paper form today in order to obtain their number, we do not see completion of the electronic version of the form to be an additional burden.

Annual Cost to Federal Government: $25,010,000

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]? 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: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov

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