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OMB Control No: 0938-1152	ICR Reference No: 202104-0938-010
Status: Historical Active	Previous ICR Reference No: 201612-0938-021
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Collection of Encounter Data from MA Organizations, Section 1876 Cost HMOs/CMPs, 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 without change	Conclusion Date: 03/16/2022
	Date Received in OIRA: 05/03/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2025	36 Months From Approved	03/31/2022
Responses	1,068,205,855	0	769,396,692
Time Burden (Hours)	35,618,759	0	19,481
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:
	86 FR 9348	02/12/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 22438	04/28/2021
Did the Agency receive public comments on this ICR? Yes

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	1,068,205,855	769,396,692	45	298,809,118
Annual Time Burden (Hours)	35,618,759	19,481	11,791	35,587,487
Annual Cost Burden (Dollars)	0	0	0	0

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to: Cutting Redundancy

Short Statement: The updated estimate is 35,606,814 total transaction hours. The total annual transaction hours have increased concurrent with significant enrollment growth in the MA program. There has been an overall increase in the number of encounter data submissions (1,068,204,429 in 2019 compared to an average of 769,389,091 (2015-2017)). CM replaced the Institutional, Professional, and DME companion guides with the Encounter Data Submission and Processing Guide, and update language within the package to reduce duplication and improve clarity. In addition, all Part D sponsors were required to complete a Payment Reconciliation System (PRS) Contract and Contact Verification Form to verify contracts and the appropriate contacts for receipt of the PRS reports. This form is no longer used, therefore, we have removed this form from this PRA package.

Annual Cost to Federal Government: $18,700,000

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? No

Agency Contact: Stephan McKenzie 410 786-1943 stephan.mckenzie@cms.hhs.gov

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