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OMB Control No: 0938-1152	ICR Reference No: 201612-0938-021
Status: Historical Active	Previous ICR Reference No: 201508-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Collection of Risk Adjustment Data from MA Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 HCPPS, MMPS, and PACE 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 with change	Conclusion Date: 04/24/2018
	Date Received in OIRA: 08/30/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	36 Months From Approved	04/30/2018
Responses	769,396,692	0	516,493,635
Time Burden (Hours)	19,481	0	34,433
Cost Burden (Dollars)	0	0	0

Abstract: CMS uses the risk adjustment data to develop individual risk scores for risk adjusted payment under Part C. As required by law, CMS also establishes the risk adjustment methodology and annually publishes the risk adjustment factors for MA organizations and other interested entities in the Advance Notice of Methodological Changes for MA Payment Rates (every February) and the Announcement of Medicare Advantage Payment Rates (every April). Risk adjustment data in particular is used to calibrate the CMS-HCC risk adjustment models using MA patterns of diagnoses, utilization, and expenditures. While establishing a risk adjustment model appropriate for the MA program is the paramount reason for collecting MA risk adjustment, there are other important uses of the data that will improve other key functions undertaken by CMS. Data is used for the calculation of Medicare Disproportionate Share Hospital (DSH) payments. CMS collects inpatient stay information for the Medicare managed care enrollees. In particular, we collect the admission date, discharge date, Health Insurance Claim Number (HICN), and Medicare hospital number/CCN. Further, we also use the data for quality review and improvement activities. For example, MA risk adjustment data may be used in the development and calculation of quality measures for MA organizations. Other uses for the data include geographical acuity studies, utilization trends and detection of abuse as defined in the False Claim Act. Additional uses for the data include verifying the accuracy and validity of the reasonable costs claimed on Cost Reports submitted by section 1876 Cost HMOs/CMPs and section 1833 HCPPs. Finally, as stated in the regulation, we use the data for Medicare coverage purposes. For example, we can use risk adjustment data for the determination of whether day limits have been exhausted and, if not, how many such days are left.

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

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 51916	08/05/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 87034	12/02/2016
Did the Agency receive public comments on this ICR? Yes

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	769,396,692	516,493,635	252,903,057
Annual Time Burden (Hours)	19,481	34,433	-14,952
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: No

Burden Reduction Due to:

Short Statement: The currently approved title for this information collection request is, “Collection of Encounter Data from Medicare Advantage Organizations.” This iteration proposes to revise the title to read, “Collection of Risk Adjustment Data from MA Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 HCPPS, MMPS), and PACE Organizations.” We have revised the CSSC Operations Submitter Application Instruction and CSSC Operations Submitter Authorization Forms (see the attached Crosswalk). Our currently approved burden estimates have not been revised as a result of these changes. While the number of respondents has been adjusted by +8 (from 683 (currently approved) to 691 (proposed), our total time estimate has decreased by -28,136 hours (664 hr -28,800 hr). This net reduction includes -28,800 hours under the Risk Adjustment Data Submission ICR along with +664 hours for the remaining ICRs. Institutional, Professional, and DME companion guides have been added to this package since the system processes all institutional, professional, and DME claims. The burden for these claims is built into the cost of effort for a plan per year that is calculated in section 12 of this Supporting Statement, listed as $840,810. DME claims for risk adjustment data is a smaller portion of Part B claims and therefore the process to create the data in the same format is reduced. We are also requiring that accountable MA management approve their contract jurisdiction before any pharmacy reconciliation reports are submitted to them by completing a PRS Contract and Contact Verification Form. We have clarified the submission timeframes in section 6 of this Supporting Statement based on the release of the reconciliation reports. This information collection effort includes a data collection instrument that is updated annually to validate accountable MA management (i.e. Survey or form).

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

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

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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