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OMB Control No: 0938-0935	ICR Reference No: 201610-0938-011
Status: Historical Active	Previous ICR Reference No: 201509-0938-013
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Medicare Advantage Application - Part C and 1876 Cost Plan Expansion Application Regulations under 42 CFR 422 (Subpart K) & 417.400 (CMS-10237)
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: 02/28/2017
	Date Received in OIRA: 11/07/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2020	36 Months From Approved	01/31/2019
Responses	310	0	500
Time Burden (Hours)	10,941	0	18,043
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.

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

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:
	81 FR 44610	07/08/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 75409	10/31/2016
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 Application and 1876 Cost Plan Expansion Application	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	310	500	-190
Annual Time Burden (Hours)	10,941	18,043	-7,102
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: Changing Regulations

Short Statement: CMS used the Contract Year (CY) 2017 data to estimate the number of projected applications/responses that we will receive for CY2018. For the CY2017 application cycle CMS noted an approximate 46% decrease in the SAE applications. We believe this decrease was attributed to the policy change which required SAE applicants to submit Health Service Delivery (HSD) tables for the entire provider network (both active and pending counties) that the plan was proposing to expand into with the SAE request. Previously in the CY 2016 application cycle SAE applicants were only required to submit HSD tables for the pending/proposed service areas. In addition, CMS noted an approximate 44% decrease in the number of SNP applications submitted when compared to CY 2016. We believe the reduction in the SNP applications in CY2017 was attributed to the policy change to remove the requirement for D-SNPs to submit applications based upon their subtypes. The technical/clarification changes are not anticipated to have any impact on the burden estimates for the CY 2018 MA application process. CMS believes the changes will assist applicants in enhancing their understanding of the application requirements and process. As such, there are no significant changes in the application content from CY2017 to CY 2018 therefore the burden is expected to remain constant for the applicant.

Annual Cost to Federal Government: $1,944,079

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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