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OMB Control No: 0938-1265	ICR Reference No: 202101-0938-011
Status: Historical Active	Previous ICR Reference No: 202006-0938-014
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: Approved without change	Conclusion Date: 04/21/2021
	Date Received in OIRA: 01/28/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2024	36 Months From Approved	04/30/2021
Responses	672	0	672
Time Burden (Hours)	18,144	0	17,920
Cost Burden (Dollars)	0	0	0

Abstract: MBES/CBES is a financial reporting system that produces Budget and expenditures for Medical Assistance and Children's Health Insurance Program. All forms (CMS-21, -21B, -37, and -64) are to be filed on a quarterly basis and need to be certified by the States to the CMS.

Authorizing Statute(s): PL: Pub.L. 116 - 16 7 Name of Law: Medicaid Services Investment and Accountability Act of 2019
   PL: Pub.L. 115 - 123 53102 Name of Law: Bipartisan Budget Act of 2018
   PL: Pub.L. 111 - 148 2301, 2501, and 2703 Name of Law: Affordable Care Act of 2009 (ACA)
   PL: Pub.L. 111 - 152 4701 and 5001 Name of Law: Affordable Care Act of 2009 (ACA)

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AT82	Final or interim final rulemaking	85 FR 87000	12/31/2020

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 37286	06/19/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 87000	12/31/2020
Did the Agency receive public comments on this ICR? Yes

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	672	672	0
Annual Time Burden (Hours)	18,144	17,920	224
Annual 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 December 31, 2020, final rule (CMS-2482-F, RIN 0938-AT82). The rule implements provisions of Bipartisan Budget Act of 2018 (BBA 2018) (Pub. L. 115-123), which includes several provisions that modify COB and TPL in relation to special treatment of certain types of care and payment in Medicaid and Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Pub. L. 111-3). Under the authority in section 1902(a)(25)(A) of the Act, our regulations at 42 CFR part 433, subpart D establishes requirements for state Medicaid agencies to support the coordination of benefits (COB) effort by identifying TPL. Sections 433.139(b)(2), (b)(3)(i) and (b)(3)(ii)(B) detail the exception to standard COB cost avoidance by allowing pay and chase for certain types of care, as well as the timeframe allowed prior to Medicaid paying claims for certain types of care. As detailed below in section 15, we estimate it will take a 224 total hours at a cost of $7,849 to collect information on TPL and report that information to CMS on CMS-64 on a quarterly basis. Since CMS-64 does not require expenditures to be reported by service type, the CMS-64 form does not require any such revisions.

Annual Cost to Federal Government: $3,492,571

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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