Evaluation of Care and Disease Management Under Medicare Advantage

Forms and Documents

Document Name	Status
DMMAOMBQuestions#2 -7_24.doc Supplementary Document	2008-07-29
DMMA-Mail Survey New (ed) 7-24-08.doc Supplementary Document	2008-07-29
DMMA Mail Survey Cover7-24.doc Supplementary Document	2008-07-29
DMMA Initial Call Cover7-24.doc Supplementary Document	2008-07-29
DMMA Mail Survey Cover7-24.doc Supplementary Document	2008-07-29
Supporting Statement B.doc Supporting Statement B	2008-04-29
Response to Comments.doc Supplementary Document	2008-04-29
Cross-walk document and Track Changes.doc Supplementary Document	2008-04-29
3_OMB supporting statement(rev 07-24-08).doc Supporting Statement A	2008-07-29

IC Document Collections

IC ID	Document Title	Status
184936	Evaluation of Care and Disease Management Under Medicare Advantage (CMS-10255) Other-Survey, Form and Letters	New

ICR Details

OMB Control No: 0938-1048	ICR Reference No: 200805-0938-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Evaluation of Care and Disease Management Under Medicare Advantage
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 with change	Conclusion Date: 07/30/2008
	Date Received in OIRA: 05/19/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2011	36 Months From Approved
Responses	475	0	0
Time Burden (Hours)	435	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CMS is conducting an evaluation of care and disease management programs under Medicare Advantage (MA), which includes a survey of all MA plans. The survey will help describe the structure and operation of these programs. The survey will gather information about MA health plans' care and disease management programs that is not available from other sources, such as relations with health providers, the use of electronic data systems, characteristics of care and disease management programs, population served, physician intervention, differences with regular MA plans and special needs plans, and evidence of effectiveness and assessment of costs. Information is collected through a one-time, self-administered mail questionnaire.

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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:
	73 FR 4869	01/28/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 22418	04/25/2008
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Evaluation of Care and Disease Management Under Medicare Advantage (CMS-10255)

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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	475	0	0	475	0	0
Annual Time Burden (Hours)	435	0	0	435	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 is conducting a qualitative evaluation of care and disease management (C/DM) programs under Medicare Advantage (MA). To date, there has not been a systematic evaluation of care and disease management programs focusing on the MA plans and population. A survey of MA plans is needed to gather information on the full range of C/DM programs that have been implemented by the plans. The findings from the survey will provide baseline information in order to proceed on other aspects of the study that will go into in-depth examinations of specific C/DM programs.

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Annual Cost to Federal Government: $132,172

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 05/19/2008

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