Medicare Advantage Applications - Part C and regulations under 42 CFR 422 subpart K

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
pra_commentsresponses (12-4).xls	Supplementary Document	Uploaded 2008-12-11	Available
Attachment - Humanna-2008-0104-0003[1].1.xls	Supplementary Document	Uploaded 2008-12-11	Available
Attachment - Ovations-2008-0104-0002[1].1.pdf	Supplementary Document	Uploaded 2008-12-11	Available
Justification for Emergency PRA Clearance.doc	Supplementary Document	Uploaded 2008-09-08	Available
Revised HSD 1MARKUP.XLS	Supplementary Document	Uploaded 2008-09-08	Available
LC-DraftRevisedProvider Contract Matrix9208final (2).doc	Supplementary Document	Uploaded 2008-09-08	Available
LC-DraftAdminContract Matrix8-13-08clean (3).doc	Supplementary Document	Uploaded 2008-09-08	Available
High level Summ_2010_Application_Revisions_090308.doc	Supplementary Document	Uploaded 2008-09-08	Available
HFLC_CMS State Certification_082208 (comments).doc	Supplementary Document	Uploaded 2008-09-08	Available
CMS Admin-Management-Contract Matrix.DOC	Supplementary Document	Uploaded 2008-09-08	Repair queued
Supporting Statement for Applications9308.doc	Supporting Statement A	Uploaded 2008-09-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8785	Medicare Advantage Applications - Part C	Other-redline	Modified

ICR Details

OMB Control No: 0938-0935	ICR Reference No: 200809-0938-012
Status: Historical Active	Previous ICR Reference No: 200801-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Advantage Applications - Part C and regulations under 42 CFR 422 subpart K
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 12/12/2008
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/12/2008
	Date Received in OIRA: 09/18/2008
Terms of Clearance: This ICR is approved consistent with revisions in response to public comments. Previous terms of clearance remain in effect.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2009	6 Months From Approved	01/31/2011
Responses	267	0	241
Time Burden (Hours)	6,490	0	5,858
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: See attached emergency justification document. This field only has a 200 max character limit, not 4000 as noted; consequently, the emergency justification is attached as a separate document.

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Authorizing Statute(s): PL: Pub.L. 110 - 275 161 Name of Law: Provisions relating to Part C
   PL: Pub.L. 108 - 173 1857 Name of Law: Medicare Advantage
  

Citations for New Statutory Requirements: PL: Pub.L. 110 - 275 161 Name of Law: Provisions relating to Part C

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AP52	Final or interim final rulemaking	73 FR 54226	09/18/2008

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Federal Register Notices & Comments
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 54160	09/18/2008
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 - Part C	CMS-10237, CMS-10214, CMS-10214	2010 INITIAL APPLICATION FOR Employer/Union Direct Contract PFFS MAO ,   2010 Application Instructions for MA Organizations to Offer New Employer/Union-Only Group Waiver Plans (EGWPs) ,   PART C -MEDICARE ADVANTAGE

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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	267	241	10	16	0	0
Annual Time Burden (Hours)	6,490	5,858	222	410	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: The enactment of MIPPA has caused minor changes since OMB approval of the 2009 applications. Based solely on the new statute and changes it mandates to the Part C program CMS estimates they will account for approximately 35% of the requested burden hours. The remaining hours requested are because CMS received more applications and SAEs than we anticipated in our previous request. We have clarified existing instructions to update applicants about the submission process. CMS encourages plans to submit a Notice of Intent (NOI). The NOIs allows organizations 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 be increased to provide a more accurate depiction of the number of applications CMS expects to receive.

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Annual Cost to Federal Government: $302,257

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: 09/18/2008

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