Medicare Advantage Applications - Part C

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10117,10118,10 General Files and Guides	Form and Instruction	Modified	Available
Form CMS-10214 EGWP Employer Group Waiver Plans	Form and Instruction	Modified	Available
Form CMS-10136 MSA Medical Savings Account Plans	Form and Instruction	Modified	Repair queued
Form CMS-10135 SAE Application Service Area Expansion for Coordinated Care Plans: Private Fee Service Plans	Form and Instruction	Modified	Available
Form CMS-10119 RPPO Application Regional PPO Plans	Form and Instruction	Modified	Available
Form CMS-10118 PFFS Application Provate Fee for Service Plans	Form and Instruction	Modified	Available
Form CMS-10117 CCP Application Coordinated Care Plans	Form and Instruction	Modified	Available
2008 APPLICATION REVIEW PROCESS.DOC	Supplementary Document	Uploaded 2007-01-19	Available
TIMELINE OF KEY ACTIVITIES FOR MEDICARE ADVANTAGE (2).doc	Supplementary Document	Uploaded 2007-01-19	Available
SNP proposal comments roll-up 011607 final.doc	Supplementary Document	Uploaded 2007-01-19	Available
2008Appcomments-Masterlist.xls	Supplementary Document	Uploaded 2007-01-19	Available
Supporting Statement - CMS 10117,10118,10119,10135,10136,10214 - 11292006.DOC	Supporting Statement A	Uploaded 2006-12-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8785	Medicare Advantage Applications	Form and Instruction	Modified	General Files and Guides
8785	Medicare Advantage Applications	Form and Instruction	Modified	Employer Group Waiver Plans
8785	Medicare Advantage Applications	Form and Instruction	Modified	Medical Savings Account Plans
8785	Medicare Advantage Applications	Form and Instruction	Modified	Application Service Area Expansion for Coordinated Care Plans: Private Fee Service Plans
8785	Medicare Advantage Applications	Form and Instruction	Modified	Application Regional PPO Plans
8785	Medicare Advantage Applications	Form and Instruction	Modified	Application Provate Fee for Service Plans
8785	Medicare Advantage Applications	Form and Instruction	Modified	Application Coordinated Care Plans

ICR Details

OMB Control No: 0938-0935	ICR Reference No: 200612-0938-009
Status: Historical Active	Previous ICR Reference No: 200608-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Advantage Applications - Part C
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 01/05/2007
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/31/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/28/2006
Terms of Clearance: This collection is approved in accordance with the following terms of clearance: By March 2007, CMS should submit draft guidance to OMB outlining when and how security and privacy laws, policy, and existing regulations apply to entities that use Federal information. The guidance should also outline how CMS will hold entities accountable for complying with appropriate privacy and security requirements. These entities may or may not be HIPAA covered entities, and should include (but are not limited to) contractors and secondary users of data.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2007	6 Months From Approved	11/30/2008
Responses	220	0	110
Time Burden (Hours)	5,580	0	3,400
Cost Burden (Dollars)	0	0	0

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Abstract: Health plans must meet regulatory requirements to enter into a contract with CMS; in order to provide health benefits to Medicare beneficiaries. The revised MA applications are the collection receptacles required.

Emergency Justfication: For the 2008 contract year, CMS is implementing several steps to reduce the person-hours necessary to complete the Part C solicitations. These steps include automating substantial portions of the Part C Plan solicitations within CMS' Health Plan Management System (HPMS) and streamlining key information previously requested by attachments. As a result of these steps, CMS must have the final language for the solicitation completed by early December. This timeline will provide CMS with the opportunity to ensure the appropriate systems testing has been completed and applicants are educated and trained in completing the solicitations within HPMS. CMS has developed a schedule for release, comment and approval of the application that supports the challenging industry timeline. CMS must determine qualified applicants prior to the first Monday in June of 2007 (June 4).

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Authorizing Statute(s): PL: Pub.L. 108 - 173 1857 Name of Law: Contracts with Medicare+Choice Organizations
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 71177	12/08/2006
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Medicare Advantage Applications	CMS-10117 CCP, CMS-10118 PFFS, CMS-10119 RPPO, CMS-10135 SAE, CMS-10136 MSA, CMS-10214 EGWP, CMS-10117,10118,10119,10135,10136,10214	Application Coordinated Care Plans ,   Application Provate Fee for Service Plans ,   Application Regional PPO Plans ,   Application Service Area Expansion for Coordinated Care Plans: Private Fee Service Plans ,   Medical Savings Account Plans ,   Employer Group Waiver Plans ,   General Files and Guides

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ICR Summary of Burden

table that charts list 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	220	110	0	110	0	0
Annual Time Burden (Hours)	5,580	3,400	0	2,180	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: CMS encouraged plans to submit a Notices of Intent (NOI). The NOIs allows plans to provide CMS an early estimate of the applications they intend to submit. NOIs will be received and entered into our Health Plan Management System (HPMS). As a result, the total burden will increased slightly to give a more accurate depiction of the number of applications CMS expects to receive. Finally, for 2008 contracts awarded in September 2007; will renew annually; unless otherwise notified by CMS. Organizations holding 2007 contracts will not need to re-apply in 2008 and may continue providing services to beneficiaries unless otherwise notified by CMS.

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Annual Cost to Federal Government: $268,535

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 12/15/2006

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