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OMB Control No: 0938-1380	ICR Reference No: 202307-0938-007
Status: Active	Previous ICR Reference No: 202003-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No: CPI-10708
Title: Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model Process and Requirements (CMS-10708)
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: 04/02/2024
	Date Received in OIRA: 07/14/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2027	36 Months From Approved	04/30/2024
Responses	83,374	0	216,380
Time Burden (Hours)	46,427	0	113,706
Cost Burden (Dollars)	0	0	0

Abstract: The Centers for Medicare & Medicaid Services (CMS) is currently testing the Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model, in limited states, under the authority of section 1115A of the Social Security Act (the Act). Section 515(b) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) added paragraph (16) to section 1834(l) of the Act, which requires that, beginning January 1, 2017, the Secretary expand the model to all states if the model expansion meets certain statutory requirements for expanding models that are tested by the Center for Medicare and Medicaid Innovation (Innovation Center) under the authority of section 1115A of the Act. The expansion criteria, described in paragraphs (1) through (3) of section 1115A(c) of the Act, require that; (1) the Secretary determines that such expansion is expected to—(A) reduce spending under applicable title without reducing the quality of care; or (B) improve the quality of patient care without increasing spending; and (2) the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that such expansion would reduce (or would not result in any increase in) net program spending under applicable titles; and (3) the Secretary determines that such expansion would not deny or limit the coverage or provision of benefits under the applicable title for applicable individuals. Because section 1834(l)(16) of the Act requires the Secretary to expand the RSNAT Prior Authorization Model to all States if it meets the statutory expansion criterial in 1115A(c)(1 through 3) of the Act, the exemption from Paperwork Reduction Act (PRA) process in 1115A(d)(3) is not applicable for the purposes of the nationwide expansion of this model. Therefore, in order to move forward with potential nationwide expansion, contingent on the Secretary’s determination that the expansion criteria are met, CMS must complete the PRA approval process, as required by chapter 35 of title 44, United States Code. As part of the process for working towards potential expansion of the RSNAT Prior Authorization Model under section 1834(1)(16) of the Act, CMS is seeking approval for the collection of information under PRA.

Authorizing Statute(s): None

Citations for New Statutory Requirements: PL: Pub.L. 114 - 20 515(a) Name of Law: Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

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:
	88 FR 19956	04/04/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 43355	07/07/2023
Did the Agency receive public comments on this ICR? Yes

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Ambulance Prior Authorization	CMS-10708

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	83,374	216,380	-133,006
Annual Time Burden (Hours)	46,427	113,706	-67,279
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: With the implementation of the nationwide expansion, model data from calendar year 2022 was used to better estimate the number of responses per year. Based on this updated data, the number of responses per year decreased from our previous estimate of 216,941 to 83,374, which decreased the burden hours per year from 113,706 to 46,427.

Annual Cost to Federal Government: $23,200,000

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. 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: Jamaa Hill 301 492-4190

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