Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10209 CCIP Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project	Form and Instruction	New	Available
Comment #1.pdf	Supplementary Document	Uploaded 0000-00-00	Repair queued
CMS disposition of Revisions to QIP & CCIP templates.doc	Supplementary Document	Uploaded 0000-00-00	Available
Supporting Stmt.doc	Supporting Statement A	Uploaded 0000-00-00	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
179877	Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project	Form and Instruction	New

ICR Details

OMB Control No: 0938-1023	ICR Reference No: 200704-0938-012
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/27/2007
	Date Received in OIRA: 04/27/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2010	36 Months From Approved
Responses	852	0	0
Time Burden (Hours)	9,227	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Social Security Act Section 1852 e and regulations at 42 CFR 152 provide CMS the statutory authority to require Medicare Advantage Organizations (MAOs) (except for private fee for service and medical savings account plans) to 1) implement a chronic care improvement program (CCIP), and 2) to initiate on self-selected Quality Improvement Project per year and submit reports on these program activities to CMS in advance of the MAOs' routine CMS Audits. This reporting process replaces the submission of information via CMS' web-based HPMS QAPI module. CMS needs this information for the purpose of assessing MA contractor compliance with the regulatory Quality requirements. The information will be used for oversight and monitoring purposes, as well as potentially initiating other groups within the agency functions like fraud/waste/abuse investigations and compliance. Respondents are Medicare Advantage Organizations. They provide health care and health insurance to Medicare beneficiaries.

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Authorizing Statute(s): None

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 55479	09/22/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 71179	12/08/2006
Did the Agency receive public comments on this ICR? Yes

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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
Chronic Care Improvement Program and Medicare Advantage Quality Improvement Project	CMS-10209 QIP, CMS-10209 CCIP	Chronic Care Improvement Program Reporting Template ,   Medicare Advantage Quality Improvement Project Reporting

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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	852	0	0	852	0	0
Annual Time Burden (Hours)	9,227	0	0	9,227	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: MAOs had been reporting on Quality Improvement Projects (QIPs) and Chronic Care Improvement Programs (CCIP)s using the electronic Health Plan Management System (HPMS). CMS received many comments that HPMS was very difficult to work with when trying to report information on their QIPs and CCIPs. These new forms are less burdensome than using HPMS.

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Annual Cost to Federal Government: $0

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: 04/27/2007

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