Regional PPO Risk-Sharing Reconciliation Cost Report

Forms and Documents

Document Name	Status
Form CMS-10233 Regional PPO Risk-Sharing Reconciliation Cost Report Form	New
CMS-10233.RPPO Supporting Statement PRA Document.doc Supporting Statement A	2007-07-27

IC Document Collections

IC ID	Document Title	Status
181538	Regional PPO Risk-Sharing Reconciliation Cost Report Form	New

ICR Details

OMB Control No: 0938-1032	ICR Reference No: 200708-0938-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Regional PPO Risk-Sharing Reconciliation Cost Report
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: 01/17/2008
	Date Received in OIRA: 08/09/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	36 Months From Approved
Responses	14	0	0
Time Burden (Hours)	1,120	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 1858 of the Social Security Act provides for risksharing to be in effect for Medicare Advantage Regional Preferred Provider Organizations RPPOs in contract years 2006 and 2007, if actual allowed costs are above or below the RPPOs established target amount. CMS will use the information collected with this cost report to calculate each RPPOs target amount and to compare the RPPOs actual allowed costs to the calculated target amounts. The reconciliation cost report will also allow CMS to apply any savings or losses to risk corridors established in the reconciliation.

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Authorizing Statute(s): US Code: 42 USC 1395w-27a Name of Law: SPECIAL RULES FOR MA REGIONAL PLANS
  

Citations for New Statutory Requirements: US Code: 42 USC 1395w-27a Name of Law: SPECIAL RULES FOR MA REGIONAL PLANS.

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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:
	72 FR 28056	05/18/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 40299	07/24/2007
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Regional PPO Risk-Sharing Reconciliation Cost Report	CMS-10233	Regional PPO Risk-Sharing Reconciliation Cost Report

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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	14	0	14	0	0	0
Annual Time Burden (Hours)	1,120	0	1,120	0	0	0
Annual Cost Burden (Dollars)	0	0	0	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: The MMA created a regional plan type and allowed for risksharing with regional providers to be in place for the 2006 and 2007 contract years. This request for collection is in response to the changes in regulations due to MMA. This is a new information collection.

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Annual Cost to Federal Government: $26,466

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: 08/09/2007

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