View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-1265	ICR Reference No: 202006-0938-014
Status: Historical Inactive	Previous ICR Reference No: 201901-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: (CMS-10529) Quarterly Medicaid and CHIP Budget and Expenditure Reporting for the Medical Assistance Program, Administration and CHIP (MBES/CBES Forms CMS-21 and -21B, -37, and -64)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule and continue	Conclusion Date: 11/02/2020
	Date Received in OIRA: 06/24/2020
Terms of Clearance: CMS shall ensure that this collection includes all of the information required by 5 CFR 1320.8(b)(3).

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	36 Months From Approved	04/30/2021
Responses	672	0	672
Time Burden (Hours)	17,920	0	17,920
Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This 2020 information collection request is associated with our June 19, 2020, proposed rule (CMS-2482-P, RIN 0938-AT82). The rule proposes to implement provisions of Bipartisan Budget Act of 2018 (BBA 2018) which includes several provisions that modify COB and TPL in both statute and regulation related to special treatment of certain types of care and payment in Medicaid and Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). Our changes are related only to the method states are required to use when reviewing and adjudicating claims for specific services. The BBA changes for which we are updating our regulation would require that states cost avoid claims when a liable third party is identified for a specific service that states were previously allowed to pay and chase. Since CMS-64 does not require expenditures to be reported by service type, the CMS-64 form does not require any such revisions. We estimate it would take 1 hour for a data entry/information processing worker to collect information on TPL and report that information to CMS on CMS-64 on a quarterly basis. In aggregate we estimate an added annual burden of 224 hours (1 hr/response x 4 responses/year x 56 respondents).

Annual Cost to Federal Government: $3,466,183

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. No

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. 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? No

Agency Contact: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov

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