View Information Collection Request (ICR) Package
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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:
0938-1296
ICR Reference No:
202105-0938-005
Status:
Historical Active
Previous ICR Reference No:
201905-0938-021
Agency/Subagency:
HHS/CMS
Agency Tracking No:
CM-CPC
Title:
Initial and Renewal Model of Care Submissions, and Off-cycle Submission of Summaries of Model of Care Changes (CMS-10565)
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:
02/03/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/31/2021
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2025
36 Months From Approved
06/30/2022
Responses
1,433
0
323
Time Burden (Hours)
5,991
0
1,732
Cost Burden (Dollars)
0
0
0
Abstract:
Medicare Advantage (MA) Special Needs Plans (SNPs) are required to submit Models of Care (MOCs) as a component of the MA application process. The Affordable Care Act (ACA) requires that all SNPs be approved by the National Committee for Quality Assurance (NCQA). This approval is based on NCQA’s evaluation of SNPs using MOC scoring guidelines developed by CMS and NCQA for the Secretary of the Department of Health and Human Services (DHHS). The MOC elements cover the following areas: MOC 1- Description of the SNP Population; MOC 2 - Care Coordination; MOC 3 - Provider Network; and MOC 4 - Quality Measurement & Performance Improvement. SNPs submit a MOC at time of their initial application and based on their scores, SNPs receive an approval for a period of 1, 2 or 3 years. After the approval period expires, SNPs are required to submit an updated MOC for review for their renewal process. CMS is also developing a MOC off-cycle revision process so that SNPs can revise the MOC to modify its processes and strategies for providing care during their MOC approval period. CMS will require that SNPs submit summaries of their MOC revisions to CMS for NCQA evaluation when a SNP makes significant changes to its MOC during the approval period. NCQA will review the summary of changes to verify that the revisions are consistent with the acceptable, high quality standards as included in the original approved MOC. CMS will begin collecting MOCs mid-January 2016 to coincide with the MA Application collection.
Authorizing Statute(s):
PL:
Pub.L. 111 - 148 3205(e)
Name of Law: The Patient Protection and Affordable Care Act (ACA)
PL:
Pub.L. 111 - 148 1859 (b)(6)(B)(iii)
Name of Law: The Bipartisan Budget Act
Citations for New Statutory Requirements:
PL: Pub.L. 111 - 148 3205(e) Name of Law: The Patient Protection and Affordable Care Act (ACA)
PL: Pub.L. 111 - 148 1859 (b)(6)(B)(iii) Name of Law: The Bipartisan Budget Act
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AT97
Final or interim final rulemaking
86 FR 5864
01/19/2021
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
85 FR 9002
02/18/2020
30-day Notice:
Federal Register Citation:
Citation Date:
86 FR 5864
01/19/2021
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
4
IC Title
Form No.
Form Name
Initial and renewal MOC Submissions
CMS-10565
Model of care matrix upload document for initial application and renewal
Off-cycle Submission of Summaries (MOC Changes)
CMS-10565
Revised Model of Care Matrix Upload Document
Tracking Face-to-Face Encounters
Training
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
1,433
323
0
1,110
0
0
Annual Time Burden (Hours)
5,991
1,732
0
4,259
0
0
Annual Cost Burden (Dollars)
0
0
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:
No
Burden Reduction Due to:
Short Statement:
The CMS-4190-F2 rule amends 42 CFR 422.101(f) to implement the new requirements legislated by the BBA of 2018 to section 1859(f) of the Act and extend them to all SNP types. We have added new requirements governing SNP enrollee care management and SNP MOC submissions that add 1,110 responses and 4,259 hr of burden. We have also revised the Model of Care Matrix Document: Initial and Renewal Submission (Attachment A) and the Model of Care Matrix Document: Off-Cycle Submission (Attachment B).
Annual Cost to Federal Government:
$731,331
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
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
08/31/2021
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